title: Tramadol-metoclopramide or remifentanil for patient-controlled analgesia during second trimester abortion: a double-blinded, randomized controlled trial.
abstract: OBJECTIVE
  To compare patient-controlled analgesia (PCA) with tramadol with PCA with remifentanil in second trimester abortion.
  
  
  METHODS
  Prospective, randomized double-blinded study
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  30 ASA physical status 1 and 2 patients undergoing a second trimester abortion.
  
  
  METHODS
  Patients received PCA with either tramadol or remifentanil. Analgesia was initiated in the tramadol group by an initial loading dose of tramadol 1.0 mg/kg with 10 mg of metoclopramide followed by a PCA bolus of 0.3 mg/kg/mL of tramadol every 5 minutes. For remifentanil, which does not require a loading dose, a placebo of 100 mL of 0.9% normal saline was given followed by PCA of 0.4 μg/kg/mL every two minutes.
  
  
  METHODS
  Women were evaluated for pain via verbal analog score (VAS; 0-100), sedation, nausea, blood pressure, pulse, and respiratory rate. On the day of discharge, women were analyzed for overall satisfaction. Primary outcome was pain scores and general satisfaction.
  
  
  RESULTS
  Analysis by time yielded no statistically significant difference in VAS scores between the groups at any point except 16-20 hours after induction of labor, when pain was lower in the tramadol group (11.3 ± 18.1 vs. 36.7 ± 27.4; P = 0.04). The average VAS score was low in both groups, with no significant differences noted between groups (P = 0.74). Satisfaction scores were high in both groups, with no significant differences noted between them (P = 0.89).
  
  
  CONCLUSIONS
  Both drugs are acceptable choices for pain control in patients undergoing second trimester abortions.
authors.affiliation: Department of Anesthesiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. sharonorbach@yahoo.com
authors.forename: Sharon
authors.initials: S
authors.lastname: Orbach-Zinger
authors.forename: Lesley
authors.initials: L
authors.lastname: Paul-Keslin
authors.forename: Ella
authors.initials: E
authors.lastname: Nichinson
authors.forename: Andrei
authors.initials: A
authors.lastname: Chinchuck
authors.forename: Shmuel
authors.initials: S
authors.lastname: Nitke
authors.forename: Leonid A
authors.initials: LA
authors.lastname: Eidelman
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000046:Academic Medical Centers; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008787:Metoclopramide / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D000077208:Remifentanil; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D014147:Tramadol; D008787:Metoclopramide; D000077208:Remifentanil