title: Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine.
abstract: BACKGROUND
  Pain control for paediatric patients undergoing tonsillectomy remains problematic. Tramadol is reported to be an effective analgesic and to have a side-effect profile similar to morphine, but is currently not licensed for paediatric use in the UK.
  
  
  METHODS
  We conducted a prospective, double-blind, randomized controlled trial in children who were scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and after obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug, we recruited 20 patients each into morphine (0.1 mg.kg(-1)), tramadol (1 mg.kg(-1)) and tramadol (2 mg.kg(-1)) groups. These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg.kg(-1)) rectally. The postoperative pain scores, analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting, as well as antiemetic requirements, were noted at 4-h intervals until discharge.
  
  
  RESULTS
  There were no statistically significant differences in age, weight, type of operation or induction of anaesthesia, 4-h sedation and pain scores and further analgesic requirements. There were no episodes of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% versus 40%, P=0.03) compared with both tramadol groups.
  
  
  CONCLUSIONS
  Tramadol has similar analgesic properties, when compared with morphine. The various pharmaceutical presentations and the availability as a noncontrolled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.
authors.affiliation: Royal Aberdeen Children's Hospital, Aberdeen, UK. t.engelhardt@abdn.ac.uk
authors.forename: Thomas
authors.initials: T
authors.lastname: Engelhardt
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Steel
authors.forename: Graham
authors.initials: G
authors.lastname: Johnston
authors.forename: Derek Y
authors.initials: DY
authors.lastname: Veitch
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D002648:Child; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D009020:Morphine / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects*; D014147:Tramadol / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine