title: Comparison of intravenous and peritonsillar infiltration of tramadol for postoperative pain relief in children following adenotonsillectomy.
abstract: OBJECTIVE
  The aim of this study was to compare the postoperative analgesic efficacy and side-effects of intravenous tramadol with peritonsillar infiltration of tramadol in children undergoing adenotonsillectomy.
  
  
  METHODS
  Sixty-six children were randomized into two groups: group I received 2 mg kg(-1) tramadol intravenously and group II received 2 mg kg(-1) tramadol in 2 ml of normal saline (1 ml per tonsil) via peritonsillar infiltration. Modified Hannallah pain scale, nausea, vomiting, bleeding, rescue analgesia, sedation and Aldrete scores were recorded at the 1st, 15th, 30th and 60th minute postoperatively. The Aldrete score was used to determine the postanaesthesia care unit discharge criteria. Patients were evaluated for the analgesic requirement, nausea and vomiting, bleeding and sedation.
  
  
  RESULTS
  There were no differences between groups during the first 1 h. In the postanaesthesia care unit, groups I and II had comparable pain scores that were not statistically significant (P > 0.05). But during the first 24 h the additional analgesic requirement of group I (141.81 mg) was more than group II (83.63 mg) (P = 0.002). Pain scores in the postoperative ward at 6, 12 and 24 h were significantly higher in group I than in group II (P < 0.001). Also four patients (12.12%) from group I and one patient (3.05%) from group II had nausea and vomiting in the postanaesthesia care unit and none of the patients had rescue analgesics. There were no differences between groups regarding nausea and vomiting, sedation and bleeding in the postoperative ward.
  
  
  CONCLUSIONS
  In adenotonsillectomy cases, peritonsillar infiltration of tramadol maintains efficient pain relief with lower incidence of nausea and vomiting.
authors.affiliation: Diskapi Training and Research Hospital, I. Anesthesia Clinic, Ankara, Turkey. akkaya@yahoo.com
authors.forename: Taylan
authors.initials: T
authors.lastname: Akkaya
authors.forename: Nurdan
authors.initials: N
authors.lastname: Bedirli
authors.forename: Tijen
authors.initials: T
authors.lastname: Ceylan
authors.forename: Erkan
authors.initials: E
authors.lastname: Matkap
authors.forename: Guven
authors.initials: G
authors.lastname: Gulen
authors.forename: Ozan
authors.initials: O
authors.lastname: Elverici
authors.forename: Haluk
authors.initials: H
authors.lastname: Gumus
authors.forename: Istemihan
authors.initials: I
authors.lastname: Akin
mesh_terms: D000233:Adenoidectomy; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000772:Anesthesia, Local / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D014068:Tonsillectomy; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol