Tramadol vs morphine during adenotonsillectomy for obstructive sleep apnea in children.
BACKGROUND
Optimal analgesia for children undergoing adenotonsillectomy for obstructive sleep apnea (OSA) is controversial. Tramadol may represent a superior choice over morphine in this group, with a potential to cause less postoperative sedation and respiratory depression. Optimal perioperative analgesia may allow expensive and time-consuming preoperative work-up and postoperative monitoring to be rationalized.


METHODS
Sixty-six children were randomized to receive either perioperative tramadol or morphine in this double blinded, prospective, controlled trial. Postoperative sedation, pain, respiratory events, and vomiting were then compared between groups.


RESULTS
There was no significant difference between the two groups in sedation scores 1 h after arrival in recovery (P = 0.24) or at any other time up to 6 h postoperation. There was also no evidence of a difference between the groups in pain scores up to 6 h postoperation. There were fewer episodes of postoperative desaturation (<94%) in the tramadol group up to 3 h postoperation, with 26% fewer episodes in the tramadol group during the second hour postoperation (P = 0.02). Overall, there was a trend toward fewer desaturation episodes in the tramadol group.


CONCLUSIONS
Tramadol may be a suitable drug for children undergoing adenotonsillectomy for OSA. Further work is required to investigate this.
Hullett
Bruce J
BJ
Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia. hullettb@yahoo.com
Chambers
Neil A
NA
Pascoe
Elaine M
EM
Johnson
Chris
C
D000233:Adenoidectomy / Q000009:adverse effects; D000698:Analgesia; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D000762:Anesthesia Recovery Period; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D008137:Longitudinal Studies; D009020:Morphine; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects; D014147:Tramadol
D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine