[Control of postoperative pain in heart surgery. Comparison of analgesics].
BACKGROUND
Evaluation of the efficacy of three analgesic drugs (tramadol, ketorolac, and morphine) for the control of postoperative pain in cardiac surgery.


METHODS



METHODS
prospective randomized study.


METHODS
University Hospital, Postoperative intensive care unit.


METHODS
sixty patients, who underwent cardiac surgery, were studied. They were randomly allocated in four groups, treated with a different postoperative analgesic therapy: A) tramadol in continuous infusion; B) ketorolac in continuous infusion; C) tramadol, in repeated boluses; D) morphine, in repeated boluses.


METHODS
the analgesic efficacy of each drug and administration protocol was evaluated by hemodynamic stability, arterial blood gases analysis, Visual Analogue Scale (VAS), resting and after cough, the VAS derivatives PID and SPID, the concentration of plasma epinephrine and norepinephrine, at eight postoperative times. Adverse effects were also registered.


RESULTS
Only tramadol, in continuous i.v. infusion, achieves the required analgesic effect, significantly decreasing both VAS scores, at the end of the administration of the drug. This treatment reduced epinephrine plasma levels in the first postoperative day, when the residual analgesic effect of surgical anesthesia can be considered disappeared.


CONCLUSIONS
Tramadol in continuous infusion (dose 12 mg/h) proved to be effective for the control of postoperative pain after cardiac surgery. The proposed dose represents a good compromise between analgesic efficacy and interference with the vital functions of operated patients.
Barilaro
C
C
Istituto di Anestesiologia e Rianimazione, Università Cattolica del S. Cuore, Largo F. Vito, 1, 00168 Roma.
Rossi
M
M
Martinelli
L
L
Guarneri
S
S
Cimino
A
A
Schiavello
R
R
D000328:Adult; D000368:Aged; D000698:Analgesia; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D014147:Tramadol / Q000008:administration & dosage / Q000009:adverse effects
D000700:Analgesics; D014147:Tramadol; D009020:Morphine; D020910:Ketorolac