Comparison of caudal vs intravenous tramadol administered either preoperatively or postoperatively for pain relief in boys

Abstract

Summary Background : In this study we compared caudal with intravenous (i.v.) tramadol given pre‐ or postoperatively for pain relief in boys having hypospadias repair. Methods : The study was approved by the Ethics Committee and informed written consent was obtained from the parents of each patient. Patients (n = 134), aged 1–3 years, American Society of Anesthesiologists (ASA) physical status I, scheduled for hypospadias surgery were recruited. The patients were randomly allocated to one of the four groups: group I (n = 33), received 2 mg·kg−1 (0.5 ml·kg−1) of caudal tramadol after the surgical procedure was completed, group II (n = 33) received 2 mg·kg−1 (0.5 ml·kg−1) of caudal tramadol before incision, group III (n = 34) received 2 mg·kg−1 tramadol intravenously, after surgery and group IV (n = 34) received 2 mg·kg−1 tramadol intravenously, after anaesthesia induction. When the patients were fully awake in the recovery area, heart rate, arterial pressure, peripheral oxygen saturation, respiratory rate, pain and sedation scores were recorded at 5, 10, 15, 30, 60 min, and 2, 3, 4, 6, 12 and 24 h postoperatively and side‐effects were noted. Pain was assessed using an objective pain score (OPS). Results : The OPS were lower in caudal tramadol groups than in i.v. tramadol groups only at 3 h (P < 0.05). The duration of postoperative analgesia was longer in the caudal groups than in the i.v. groups (P = 0.001). However, the duration of postoperative analgesia was unaffected by the timing of administration. Conclusions : Caudal tramadol provides better and longer lasting postoperative analgesia than i.v. tramadol. These results also suggest that preoperative caudal tramadol did not provide any clinically perceptible benefits compared with postoperative caudal tramadol.

Epidural ropivacaine versus ropivacaine plus tramadol in postoperative analgesia in children undergoing major abdominal surgery: a comparison

“…Tramadol has hydrophilic properties similar to morphine; thus, it binds less to fat and provides a higher concentration gradient that enhances absorption into the cerebrospinal fluid (CSF) [30]. Gunes and colleagues [31] concluded that caudal tramadol (2 mg/kg) provided better and long-lasting postoperative analgesia ([24 h) than i.v. tramadol 2 mg/kg (2.20 h).…”

Neuraxial Analgesia in Neonates and Infants

“…Minimal dose sparing has also been demonstrated with ketamine, as 0.5 to 1mg/kg is utilized in caudal studies 97,98 and the same dose systemically provides procedural sedation and analgesia 99–101 , albeit for a shorter duration 102 . Similarly, analgesia was prolonged when comparing caudal and intravenous administration of 2mg/kg tramadol 103 . Clonidine via the intrathecal 104 or caudal 105 route has a greater effect on analgesic duration than the same dose intravenously, but effects on general anesthetic requirements and early post-operative sedation are seen with neuraxial and systemic administration.…”

“…Morphine or fentanyl has been used most frequently in neonates and infants 22,25,30 , but the use of a wide range of opioid drugs has been reported in children 6 months and older including: alfentanil 112 , sufentanil 113–115 , buprenorphine 116 , butorphanol 117–119 , diamorphine, 120,121 , hydromorphone 122 and tramadol 103,123–127 . In surveys of UK pediatric anesthetists, 85% used opioids for epidural analgesia 77 , but variability in the agent chosen (fentanyl, morphine, or diamorphine) was noted in this and an earlier survey (21% adding fentanyl and 13% adding diamorphine to caudal anesthetic blocks) 109 .…”

The Perioperative Management of Pain from Intracranial Surgery

“…Thus, tramadol may offer significant advantages in the management of pain following intracranial surgery by virtue of its dual mechanism of action, its lack of a ceiling effect, and its minimal respiratory depression. Tramadol may be administered orally, rectally, or intravenously [82,83]. Oral and intravenous tramadol is administered in doses of 1-2 mg/kg; the higher dose provides a longer duration of action without increasing side effects.…”