Tramadol vs morphine during adenotonsillectomy for obstructive sleep apnea in children

Hullett, Bruce; Chambers, Neil; Pascoe, Elaine M.; Johnson, Chris

doi:10.1111/j.1460-9592.2005.01827.x

Cited by 62 publications

(31 citation statements)

References 19 publications

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“…When compared with morphine, tramadol was shown to result in fewer respiratory events post-tonsillectomy 36 ; however, further work is required to assess the safety of tramadol as an alternative analgesic. A retrospective review identified a reduction in recurrent hypoxemia after adenotonsillectomy in children who have severe OSA resulting from dexamethasone administration (∼2.4 mg/kg) and a reduction opioid dose.…”

Section: Figurementioning

confidence: 99%

Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial

et al. 2015

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Section: Figurementioning

confidence: 99%

Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial

et al. 2015

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“…[2][3][4][5][6] Tramadol, a racemic opioid widely used for mild to moderately severe acute pain management, has been proposed as an alternative to codeine because it is thought to be associated with decreased postoperative sedation and respiratory depression. 7 Tramadol is extensively metabolized in the liver by the cytochrome P450 monooxygenases followed by conjugation reactions producing inactive glucuronides and sulfates (for details, https://www.pharmgkb.org/ pathway/PA165946349). Its main analgesic metabolite (M1) results from the O-demethylation catalyzed by the cytochrome P450 CYP2D6.…”

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confidence: 99%

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

Orliaguet¹,

Hamza²,

Couloigner

et al. 2015

Pediatrics

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We discuss a case of severe respiratory depression in a child, with ultrarapid CYP2D6 genotype and obstructive sleep apnea syndrome, after taking tramadol for pain relief related to a day-case tonsillectomy.Pain management is challenging after ambulatory tonsillectomy in children and has become more so since the publication of restrictions on the use of codeine for pain relief in children. 1 These restrictions followed reports of severe and fatal respiratory depression in children after the use of codeine for pain relief. [2][3][4][5][6]

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“…This study was a single-dose RCT examining the effectiveness of intravenous (IV) tramadol versus IV morphine following adenotonsillectomy in 66 pediatric patients 1 to 8 years old. 11 The RR of patients experiencing at least 1 desaturation episode was 1.63 times greater in patients who received morphine as compared to patients who received tramadol (95% CI: 0.64-6.13). An additional study by Zhuang and colleagues 12 reported no difference in the incidence of respiratory depression between patients receiving postoperative IV dexmedetomidine or IV morphine (p=0.85).…”

Section: Resultsmentioning

confidence: 99%

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

Whittaker

2013

The Journal of Pediatric Pharmacology and Therapeutics

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BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64-6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients. INDEX TERMS

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Tramadol vs morphine during adenotonsillectomy for obstructive sleep apnea in children

Abstract: Tramadol may be a suitable drug for children undergoing adenotonsillectomy for OSA. Further work is required to investigate this.

Cited by 62 publications

References 19 publications

Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial

Morphine or Ibuprofen for Post-Tonsillectomy Analgesia: A Randomized Trial

A Case of Respiratory Depression in a Child With Ultrarapid CYP2D6 Metabolism After Tramadol

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

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