title: Intraoperative administration of tramadol for postoperative nurse-controlled analgesia resulted in earlier awakening and less sedation than morphine in children after cardiac surgery.
abstract: In adults, intraoperative administration of tramadol could result in earlier recovery and less sedation than morphine. In this controlled, randomized, double-blind study, we investigated whether an intraoperative initial dose of tramadol could cause more rapid awakening from general anesthesia, less sedation, and earlier tracheal extubation than morphine in children during the immediate postoperative period. Forty children aged 1-6 yr, scheduled for atrial or ventricular septal defect repair and tracheal extubation in the pediatric intensive care unit, were randomly allocated to receive morphine, initial dose 0.2 mg/kg, or tramadol 2 mg/kg given at the end of sternal closure, followed by nurse-controlled analgesia (bolus 0.02 mg/kg of morphine and 0.2 mg/kg of tramadol) with background infusions (0.015 mg x kg(-1) x h(-1) for morphine and 0.15 mg x kg(-1) x h(-1) for tramadol). Postoperatively, children receiving tramadol had earlier awakening from general anesthesia (P = 0.02) and were less sedated at 1 and 2 h postoperatively (P = 0.03 and P = 0.01, respectively). Tracheal extubation was earlier in the tramadol group (P = 0.01). Lengths of pediatric intensive care unit stay did not differ between groups. Times to first trigger of nurse-controlled analgesia bolus and objective pain scores during the 48 h observation period were comparable between groups. The incidence of desaturation and emesis were similar between groups. The patients ate well and did not differ on Day 1 or Day 2.
authors.affiliation: Department of Anesthesiology Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Ya-Chun
authors.initials: YC
authors.lastname: Chu
authors.forename: Su-Man
authors.initials: SM
authors.lastname: Lin
authors.forename: Ying-Chou
authors.initials: YC
authors.lastname: Hsieh
authors.forename: Kwok-Hon
authors.initials: KH
authors.lastname: Chan
authors.forename: Mei-Yung
authors.initials: MY
authors.lastname: Tsou
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D020878:Device Removal; D004311:Double-Blind Method; D005260:Female; D006343:Heart Septal Defects / Q000601:surgery; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007432:Intraoperative Period; D007442:Intubation, Intratracheal; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D012119:Respiration / Q000187:drug effects; D014147:Tramadol / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine