The Relationship Between Tramadol Use and Cardio Electrophysiological Balance for Postoperative Pain Treatment in General Surgery Patients

Abstract

Background and Objective: This study aimed to investigate the relationship between tramadol use and cardio electrophysiological imbalance (iCEB/iCEBc) in general surgery patients with complaints of acute postoperative pain (APP). Materials and Methods: In this prospective cross-sectional study, a total of 218 consecutive patients over the age of 18, who underwent surgical procedures in our clinic (postoperative), were included. For analgesic effect, tramadol was administered with an initial total max dose not exceeding 2 mg/kg. A single max dose (100 mg) was given intravenously, infused in 100 cc of saline over 60 min. In all patients requiring analgesia, electrocardiography (ECG) was performed in the supine position with 12 leads at 25 mm/s and 10 mm/mV, immediately before and after tramadol administration. iCEB was calculated as QT/QRS and iCEBc as QTc/QRS. Results: A total of 218 patients were included in this study, with 98 of them being male (45%) and the average age being 46.20 ± 17.19 years. The average tramadol dose for analgesic effect was 98.21 ± 7.62 mg. The QT interval (339.17 ± 36.27 vs. 349.88 ± 30.86, p = 0.001), QTc interval (407.07 ± 26.36 vs. 419.64 ± 31.78, p < 0.001), QRS duration (80.82 ± 11.39 vs. 78.57 ± 9.80, p = 0.018), iCEB (4.26 ± 0.69 vs. 4.52 ± 0.70, p < 0.001), and iCEBc (5.14 ± 0.86 vs. 5.42 ± 0.79, p = 0.001) values significantly increased compared to the baseline immediately after drug administration. Furthermore, the drug dose was identified as an independent predictor that increased iCEBc (β = 0.201, p = 0.003). Conclusions: Even at single and therapeutic doses, tramadol increases iCEB and iCEBc. Additionally, the drug dose is an independent predictor of increased iCEBc.