Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study

Abstract

BackgroundThis study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia.MethodsSeventy-seven patient, aged 2–12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded.ResultsDexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D.ConclusionBoth tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration.Trial registrationRetrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016

The effects of dexmedetomidine and tramadol on post‐operative pain and agitation, and extubation quality in paediatric patients undergoing adenotonsillectomy surgery: A randomized trial

“…Only one study in this meta-analysis compared the effects of dexmedetomidine and tramadol; it found that both tramadol and dexmedetomidine were effective for controlling pain and the emergence of agitation. 18 Similarly, we also showed that post-operative pain and agitation were significantly lower in patients who received dexmedetomidine compared with tramadol. Based on these results, we conclude that dexmedetomidine provides more effective pain and agitation control than tramadol in paediatric patients who undergo adenotonsillectomy surgery using sevoflurane.…”

“…A subgroup analysis showed that dexmedetomidine decreased the severity and frequency of agitation more effectively than other opioids. Only one study in this meta‐analysis compared the effects of dexmedetomidine and tramadol; it found that both tramadol and dexmedetomidine were effective for controlling pain and the emergence of agitation . Similarly, we also showed that post‐operative pain and agitation were significantly lower in patients who received dexmedetomidine compared with tramadol.…”

Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis

“…Although the sedative effect of dexmedetomidine could cause the residual sedation, dexmedetomidine would not influence the duration of staying PACU, regardless of the administration method. For these results, we could consider several points.…”

“…Fifteen studies with 1,552 participants were included for the meta-analysis, and the results of the study characteristics were described in Table I. Outcomes for analysis were postoperative pain (pain scores) in the postanesthesia care unit (PACU), [10][11][12][13][14][15][16][17][18] postoperative analgesic requirements (doses of postoperative opioids or nonopioid analgesics), 4,8,[10][11][12]16,17,[19][20][21][22][23][24][25][26][27][28][29][30] postoperative agitation (agitation scores and incidence during recovery), 8,10,11,13,[15][16][17][18][19][21][22][23]31 desaturation, 8,10,15,17,18,20,…”

Effect of dexmedetomidine combined with sufentanil on preventing emergence agitation in children receiving sevoflurane anesthesia for cleft palate repair surgery

“…However, numerous studies have demonstrated that sevoflurane anesthesia in patients had a higher risk of postoperative agitation, particularly in children (8,9). The incidence rate of EA varies depending on the type and severity of EA.…”