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Intravenous patient-controlled analgesia after thoracotomy: a comparison of morphine with tramadol

Published online by Cambridge University Press:  02 June 2005

H. Erolçay  and
L. Yüceyar
H. Erolçay
Affiliation:
İstanbul University, Cerrahpaşa Medical Faculty, Department of Anaesthesiology, Istanbul, Turkey
L. Yüceyar
Affiliation:
İstanbul University, Cerrahpaşa Medical Faculty, Department of Anaesthesiology, Istanbul, Turkey
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Abstract

Summary

Background and objective: This study examined the quality of analgesia together with the side-effects produced by tramadol compared with morphine using intravenous patient-controlled analgesia during the first 24 h after thoracotomy.

Methods: Forty-four patients scheduled for thoracotomy were included in the study. Morphine 0.3 mg kg−1 was given interpleurally 20 min before a standard general anaesthetic. In the postanaesthetic care unit, the patients were randomly allocated to one of two groups to self-administer tramadol or morphine using a patient-controlled analgesia device throughout a 24 h period. The patient-controlled analgesia device was programmed to deliver tramadol 20 mg as an intravenous bolus or morphine 2 mg with a lockout time of 10 min.

Results: Mean cumulative morphine and tramadol consumption were 48.13 ± 30.23 and 493.5 ± 191.5 mg, respectively. There was no difference in the quality of analgesia between groups. Five (26.3%) patients in the tramadol group and seven (33%) in the morphine group had nausea, and three of the latter patients vomited. The incidence rate of vomiting with tramadol was 5.2%. All vital signs were within safe ranges. Sedation was less in the tramadol group, but not statistically significant.

Conclusions: In this clinical setting, which includes interpleural morphine pre-emptively, postoperative analgesia provided by tramadol was similar to that of morphine at rest and during deep inspiration. Side-effects were slight and comparable between the patients receiving morphine and tramadol.

Keywords

ANALGESIA, patient-controlledANALGESICS, OPIOID, morphine, tramadolPAIN, postoperativePOSTOPERATIVE COMPLICATIONS, postoperative nausea and vomitingTHORACIC SURGICAL PROCEDURES, thoracotomy
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 2 , February 2003 , pp. 141 - 146
Copyright
2003 European Society of Anaesthesiology

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References

Conacher ID. Pain relief after thoracotomy. Br J Anaesth 1990; 65: 806–812.Google Scholar
Raffa RB, Friderichs E. The basic science aspect of tramadol hydrochloride. Pain Rev 1996; 3: 249–271.Google Scholar
Budd K, Langorf R. Tramadol revisited. Br J Anaesth 1999; 82: 493–495.Google Scholar
Vickers MD, O'Flaherty D, Szekely SM, Read M, Yoshizumi J. Tramadol: pain relief by an opioid without depression of respiration. Anaesthesia 1992; 47: 291–296.Google Scholar
James MFM, Heijke SAM, Gordon PC. Intravenous tramadol versus epidural morphine for postthoracotomy pain relief: a placebo-controlled double-blind trial. Anesth Analg 1996; 83: 87–91.Google Scholar
Etches RC, Gammer TL, Cornish R. Patient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine. Anesth Analg 1996; 83: 81–86.Google Scholar
Tsui SL, Chan CS, Chan AS, et al. Postoperative analgesia for oesophageal surgery: a comparison of three analgesic regimens. Anaesth Intensive Care 1991; 19: 329–337.Google Scholar
Bromage PR, Camporesi E, Chestnut D. Epidural narcotics for postoperative analgesia. Anesth Analg 1980; 59: 473–480.Google Scholar
Coetzee JF, van Loggerenberg H. Tramadol or morphine administrated during operation: a study of immediate postoperative effects after abdominal hysterectomy. Br J Anaesth 1998; 81: 737–741.Google Scholar
Montes A, Warner W, Puig PP. Use of intravenous patient-controlled analgesia for the documentation of synergy between tramadol and metamizol. Br J Anaesth 2000; 85: 217–223.Google Scholar
Zarauza R, Saez-Fernandez AN, Iribarren MJ, et al. A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia. Anesth Analg 2000; 91: 938–943.Google Scholar
Cepeda SM, Delgado M, Ponce M, Cruz CA, Carr DB. Equivalent outcomes during postoperative patient-controlled intravenous analgesia with lidocaine plus morphine versus morphine alone. Anesth Analg 1996; 83: 102–106.Google Scholar
Hopkins D, Shipton EA, Potgieter D, et al. Comparison of tramadol and morphine via subcutaneous PCA following major orthopaedic surgery. Can J Anaesth 1998; 45: 435–442.Google Scholar
Kavanagh BP, Katz J, Sandler AN, et al. Multimodal analgesia before thoracic surgery does not reduce postoperative pain. Br J Anaesth 1994; 73: 184–189.Google Scholar
Lehmann KA, Kratzenberg U, Schroeder-Bark B, Horrichs-Haermeyer G. Postoperative patient-controlled analgesia with tramadol: analgesic efficacy and minimum effective concentrations. Clin J Pain 1990; 6: 212–220.Google Scholar
Silvasti M, Svarlting N, Pitkanen M, Rosenberg H. Comparison of intravenous patient-controlled analgesia with tramadol versus morphine after microvascular breast reconstruction. Eur J Anaesthesiol 2000; 17: 448–455.Google Scholar
Silvasti M, Tarkkila P, Tuominen M, Svartling N, Rosenberg PH. Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillo-facial surgery. Eur J Anaesthesiol 1999; 16: 834–839.Google Scholar
Ng KFJ, Tsui SL, Yang JCS, Ho ETF. Increased nausea and dizziness when using tramadol for post-operative patient-controlled analgesia (PCA) compared with morphine after intraoperative loading with morphine. Eur J Anaesthesiol 1998; 15: 565–570.Google Scholar
Stamer UM, Maier C, Grond S, Veh-Schmidt B, Klaschilk E, Lehmann KA. Tramadol in the management of post-operative pain: a double-blind placebo and active drug-controlled study. Eur J Anaesthesiol 1997; 14: 646–654.Google Scholar
Houmes RM, Voets MA, Verkaaik A, Erdmann W, Lachmann B. Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression. Anesth Analg 1992; 74: 510–514.Google Scholar
Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999; 91: 109–118.Google Scholar
Cohen MM, Duncan PG, De Boer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78: 7–16.Google Scholar
Quinn AC, Brown JH, Wallace PG, Asbury AJ. Studies in postoperative sequelae. Nausea and vomiting – still a problem. Anaesthesia 1994; 49: 62–65.Google Scholar
Aykaç B, Erolçay H, Dikmen Y, Öz H, Yillar O. Comparison of interpleural versus intravenous morphine for postthoracotomy pain management. J Cardiothorac Vasc Anaesth 1995; 9: 538–540.Google Scholar