Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery

Abstract

Purpose: To compare subcutaneous PCA tramadol with subcutaneous PCA morphine for postoperative pain relief after major orthopaedic surgery and for the incidence of side-effects. Methods: In a double-blind randomised controlled study 40 patients (20 in each group) self-administered either tramadol or morphine for 72 hr after surgery via sr PCA. The following variables were recorded at various time inter~ vals: (I) pain score by means of a visual analogue scale, (ii) drug consumption and total PCA demands, (iii) vital signs (blood pressure and heart rate), (iv) oxygen saturation and respiratory rate, and (v) side-effects (sedation, nausea~om-iting, pruritus, urinary retention and constipation). Results: Both drugs provided effective analgesia. The mean consumption in the first 24 hr was 792 _+ 90 mg tramadol and 42 -+ 4 mg morphine. Thereafter, consumption of both drugs declined markedly. Moderate haemodynamic changes were observed in both the tramadol and morphine groups (with a maximum 20% decrease in mean blood pressure and a maximum 17% increase in heart rate) during the 72 hr period. Both tramadol and morphine were associated with a clinically and statistically significant (P < 0.001) decrease in oxygen saturation, but without changes in respiratory rates. Desaturation was less marked with tramadol. Tramadol appeared to cause more nausea and vomiting than morphine. Sedation was mild and only seen during the first few hours after surgery in both groups. Conclusion: Tramadol is an effective analgesic agent for the relief of acute postoperative pain when administered by PCA via the subcutaneous route. Under these conditions tramadol behaves much like morphine with a similar side-effect profile.

Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

“…22) Similar side eŠects for tramadol and morphine were reported earlier. 23) Tramadol caused a higher incidence of nausea and vomiting, which concurred with ourˆndings except that meperidine group showed a higher tendency for sedation. In the present study, it was observed that side eŠects such as nausea and vomiting were more often in tramadol group than morphine, fentanyl and meperidine group.…”

Pharmacokinetics, safety and tolerance of single- and multiple-dose of a novel compound tramadol hydrochloride injection (35 mg tramadol hydrochloride, 45 mgl promethazine hydrochloride) in Chinese healthy subjects

“…history of allergy to Tramadol or Promethazine, or history of nervous or psychic diseases; (6) no drugs, or other medications, or any kind of clinical trial which might interfere with absorption, distribution, metabolism or excretion of Tramadol and Promethazine or harmful to human organs 3 months before or during the study; (7) voluntary signature of an informed consent form.…”

“…It had been reported that side effects such as nausea and vomiting were more often in Tramadol than Morphine, Fentanyl and Meperidine (4)(5)(6)(7). And other study reported that high-dose tramadol induced seizures, its most prominent toxicity (not respiratory depression) in all species tested (4).…”

The role of tramadol in cancer pain treatment—a review

“…If tramadol analgesia is ineffective a change to a strong opioid analgesic is recommended. The relative potency of tramadol to morphine is about 1:5 to 1:4 for the oral route and about 1:10 for the subcutaneous and intravenous routes, but experimental data [58] and one study in postoperative pain [22] indicate that the latter is rather 1:20.…”