Comparing the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain

Abstract

The aim of the study was to compare the effects of peritonsillar infiltration of tramadol before and after the surgery on post-tonsillectomy pain. In this double-blinded clinical trial study, 80 children aged 5-12 years old with ASA (American Society of Anesthesiologists) class I or II undergoing tonsillectomy involved. In group A (n = 40), after anesthesia induction and before starting the surgery, tramadol 2 mg/kg diluted in normal saline up to 2 cc total volume was injected into the tensile bed by the anesthesiologist using a 25 gauge needle. Surgery began 3 min later and the tonsils were removed using the sharp dissection method. In children of group B (n = 40), anesthesia induction was performed. When surgery was completed, tramadol 2 mg/kg diluted in normal saline up to 2 cc total volume was injected at the site of removing each tonsil using a 25 gauge needle by the anesthesiologist. Using the CHEOPS (Children's Hospital of Eastern Ontario Pain Scale) Scale, pain recorded at different times. Patient sedation was recorded using the RAMSAY Sedation Scale. All the data were analyzed using SPSS 17 statistical software. Two groups significantly felt different pain intensities at different times following the surgery. At the three times, the mean sedation score in the group receiving tramadol infiltration before surgery was a little higher compared to the other group, but this difference was not significant (p > 0.05). As for the relative frequency of nausea and vomiting, the difference was not significant (p = 0.793). Request for analgesics between the groups was not significant (p = 0.556). The mean time of the first feeding after the surgery was not significant between the groups (p = 0.062). Surgical duration was almost the same for both groups (p > 0.05). Systolic blood pressures (before surgery, before extubation, and after extubation) were statistically the same in both groups (p < 0.05). Furthermore, systolic blood pressures 10, 15, and 30 min after entry into the recovery room were the same in both groups. We concluded that peritonsillar infiltration of tramadol before surgery controlled postoperative pain better from 8 h after the surgery to hospital discharge (late effect), but that local infiltration of tramadol after surgery controlled postoperative pain better up to 2 h after the operation (early effect).

Analgesic Efficacy and Safety of Local Infiltration of Tramadol in Pediatric Tonsillectomy Pain: A Systematic Review and Meta‐Analysis

“…Seven of them were considered inappropriate for inclusion in the final analysis due to methodological constraints or non‐English full‐text publication. The selected articles consisted of 12 RCTs enrolling a total of 972 children, among which 345 were assigned to the tramadol peritonsillar infiltration group and the remaining 627 in the placebo or active comparator groups. All of these studies met the criteria to be included in the final qualitative appraisal, whilst 8 RCTs incorporating both a comparison to the placebo group and tramadol dosing of 2 mg/kg were deemed eligible to be included in the quantitative analysis .…”

“…The majority of the included RCTs implemented a 3‐arm study design, whilst 2 or 4 comparison groups were incorporated in 4 and 3 RCTs, respectively.…”

“…Pre‐incisional application of local infiltration of tramadol was adopted by the majority of study designs, with the exception of 3 RCTs implementing this practice after tonsillectomy conclusion . Standard dosing of tramadol (2 mg/kg) was recorded in all included studies but one, which applied 0.1 mg/kg of tramadol for local infiltration …”

“…Besides the intravenous route that has been customarily used for the administration of analgesic drugs, their application as infiltration of the surgical field has been suggested as an attractive alternative in children subjected to tonsillectomy . In line with this, infiltration of the peritonsillar bed with tramadol—which holds both systemic analgesic and neurotransmission blocking properties—has emerged as a promising practice in terms of postoperative pain control and minimization of side‐effects, applied as either a sole regimen or adjuvant to other analgesic modalities . This could be of importance under the light of the aforementioned FDA warning …”

Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children

“…A number of behavioral scales have been developed which include these symptoms. 7 The most commonly used ones are the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), [8][9][10] Face, Legs, Activity, Cry and Consolability (FLAAC) 9,[11][12][13] and the Children and Infants' Postoperative Pain Scale (CHIPPS). [14][15][16][17]…”