title: Tramadol for pain relief in children undergoing herniotomy: a comparison with ilioinguinal and iliohypogastric blocks.
abstract: BACKGROUND
  Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Preoperative ilioinguinal and iliohypogastric nerve blocks have been widely used to provide analgesia in children undergoing herniorrhaphy. Tramadol is an analgesic with micro-opioid and nonopioid activity. In this study we compared the usage of intravenous tramadol with ilioinguinal and iliohypogastric nerve blocks for control of post-herniorrhaphy pain in children aged 2-7 years.
  
  
  METHODS
  Sixty patients were randomly allocated to two groups of thirty. One group received tramadol 1.5 mg.kg(-1) i.v. before induction of general anesthesia and the other had an ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine (0.25 ml.kg(-1)) before skin incision. We assessed pain using the Children's Hospital of Eastern Ontario Pain Scale and the Categorical Pain Scale.
  
  
  RESULTS
  At 1, 4 and 24 h after surgery the two groups had identical pain scores. At 2 and 3 h after surgery the tramadol group experienced significantly less pain (P < 0.05). The rescue drug for residual pain, was used equally in the two groups. None of the 60 patients had respiratory depression but the tramadol group patients were found to have more episodes of nausea and vomiting (P < 0.05).
  
  
  CONCLUSIONS
  We concluded that tramadol can have at least the same analgesic effect as that of ilioinguinal and iliohypogastric nerve blocks for post-herniorrhaphy pain in children, with even a superior effect at the time of maximal analgesia. We also highlight the troublesome side-effect of nausea and vomiting which brings into question the benefits of using this opioid that seems to lack respiratory depression.
authors.affiliation: Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran. Khosravimb@sums.ac.ir
authors.forename: Mohammad Bagher
authors.initials: MB
authors.lastname: Khosravi
authors.forename: Sasan
authors.initials: S
authors.lastname: Khezri
authors.forename: Simin
authors.initials: S
authors.lastname: Azemati
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local; D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D005260:Female; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D014147:Tramadol / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D002045:Bupivacaine