Tramadol for pain relief in children undergoing tonsillectomy: A comparison with morphine

Thomas Engelhardt, E. Steel, G. Johnston

    Research output: Contribution to journalArticle

    Abstract

    Introduction Pain control for paediatric patients undergoing tonsillectomy remains problematic. The combination of intra-operative morphine and rectal diclofenac results in a high incidence of post-operative nausea and vomiting as well further analgesic requirements. Tramadol is reported to be an effective analgesic and have a side effect profile similar to morphine. It is not classed as a controlled drug and is available in tablet, suppository and injection form. It is currently not licensed for paediatric use in the UK.
    Methods We conducted a prospective, double blind, randomised controlled trial in children scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug in paediatrics we recruited 60 patients into three groups: morphine (0.1 mg·kg-1), tramadol (1 mg·kg-1) and tramadol (2 mg·kg-1). These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg-1) rectally. The post-operative analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting as well as antiemetic requirements were noted at 4 hourly intervals until discharge. Statistical analysis was performed using chi-square, Kruskal–Wallis and one-way anova tests as appropriate. P < 0.05 was considered statistically significant.
    Results There were no statistical significant differences in age, weight, type of operation or induction of anaesthesia, 4 hourly sedation and pain scores and further analgesic requirements. There were no incidences of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% vs 40%, P = 0.03) when compared to both tramadol groups. The differences in anti-emetic requirements did not reach statistically significant difference (P = 0.078).
    Conclusions We conclude that tramadol has similar analgesic properties and side effects when compared with morphine. The pharmaceutical presentation and the availability as a non-controlled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.
    Original languageEnglish
    Pages (from-to)834-835
    Number of pages1
    JournalPediatric Anesthesia
    Volume12
    Issue number9
    DOIs
    Publication statusPublished - Nov 2002

    Fingerprint

    Tramadol
    Tonsillectomy
    Morphine
    Analgesics
    Pediatrics
    Pain
    Anesthesia
    Vomiting
    Pharmaceutical Preparations
    Antiemetics
    Diclofenac
    Respiratory Insufficiency
    Nausea
    Incidence
    Suppositories
    Ethics Committees
    Injections
    Licensure
    Tablets
    Randomized Controlled Trials

    Cite this

    Tramadol for pain relief in children undergoing tonsillectomy : A comparison with morphine. / Engelhardt, Thomas; Steel, E.; Johnston, G.

    In: Pediatric Anesthesia, Vol. 12, No. 9, 11.2002, p. 834-835.

    Research output: Contribution to journalArticle

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    abstract = "Introduction Pain control for paediatric patients undergoing tonsillectomy remains problematic. The combination of intra-operative morphine and rectal diclofenac results in a high incidence of post-operative nausea and vomiting as well further analgesic requirements. Tramadol is reported to be an effective analgesic and have a side effect profile similar to morphine. It is not classed as a controlled drug and is available in tablet, suppository and injection form. It is currently not licensed for paediatric use in the UK. Methods We conducted a prospective, double blind, randomised controlled trial in children scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug in paediatrics we recruited 60 patients into three groups: morphine (0.1 mg·kg-1), tramadol (1 mg·kg-1) and tramadol (2 mg·kg-1). These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg-1) rectally. The post-operative analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting as well as antiemetic requirements were noted at 4 hourly intervals until discharge. Statistical analysis was performed using chi-square, Kruskal–Wallis and one-way anova tests as appropriate. P < 0.05 was considered statistically significant. Results There were no statistical significant differences in age, weight, type of operation or induction of anaesthesia, 4 hourly sedation and pain scores and further analgesic requirements. There were no incidences of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75{\%} vs 40{\%}, P = 0.03) when compared to both tramadol groups. The differences in anti-emetic requirements did not reach statistically significant difference (P = 0.078). Conclusions We conclude that tramadol has similar analgesic properties and side effects when compared with morphine. The pharmaceutical presentation and the availability as a non-controlled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.",
    author = "Thomas Engelhardt and E. Steel and G. Johnston",
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    N2 - Introduction Pain control for paediatric patients undergoing tonsillectomy remains problematic. The combination of intra-operative morphine and rectal diclofenac results in a high incidence of post-operative nausea and vomiting as well further analgesic requirements. Tramadol is reported to be an effective analgesic and have a side effect profile similar to morphine. It is not classed as a controlled drug and is available in tablet, suppository and injection form. It is currently not licensed for paediatric use in the UK. Methods We conducted a prospective, double blind, randomised controlled trial in children scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug in paediatrics we recruited 60 patients into three groups: morphine (0.1 mg·kg-1), tramadol (1 mg·kg-1) and tramadol (2 mg·kg-1). These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg-1) rectally. The post-operative analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting as well as antiemetic requirements were noted at 4 hourly intervals until discharge. Statistical analysis was performed using chi-square, Kruskal–Wallis and one-way anova tests as appropriate. P < 0.05 was considered statistically significant. Results There were no statistical significant differences in age, weight, type of operation or induction of anaesthesia, 4 hourly sedation and pain scores and further analgesic requirements. There were no incidences of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% vs 40%, P = 0.03) when compared to both tramadol groups. The differences in anti-emetic requirements did not reach statistically significant difference (P = 0.078). Conclusions We conclude that tramadol has similar analgesic properties and side effects when compared with morphine. The pharmaceutical presentation and the availability as a non-controlled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.

    AB - Introduction Pain control for paediatric patients undergoing tonsillectomy remains problematic. The combination of intra-operative morphine and rectal diclofenac results in a high incidence of post-operative nausea and vomiting as well further analgesic requirements. Tramadol is reported to be an effective analgesic and have a side effect profile similar to morphine. It is not classed as a controlled drug and is available in tablet, suppository and injection form. It is currently not licensed for paediatric use in the UK. Methods We conducted a prospective, double blind, randomised controlled trial in children scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug in paediatrics we recruited 60 patients into three groups: morphine (0.1 mg·kg-1), tramadol (1 mg·kg-1) and tramadol (2 mg·kg-1). These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg-1) rectally. The post-operative analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting as well as antiemetic requirements were noted at 4 hourly intervals until discharge. Statistical analysis was performed using chi-square, Kruskal–Wallis and one-way anova tests as appropriate. P < 0.05 was considered statistically significant. Results There were no statistical significant differences in age, weight, type of operation or induction of anaesthesia, 4 hourly sedation and pain scores and further analgesic requirements. There were no incidences of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% vs 40%, P = 0.03) when compared to both tramadol groups. The differences in anti-emetic requirements did not reach statistically significant difference (P = 0.078). Conclusions We conclude that tramadol has similar analgesic properties and side effects when compared with morphine. The pharmaceutical presentation and the availability as a non-controlled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK.

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