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• W2162746864 abstract "Objective: To compare the efficacy and side effects related to Tramadol with Pethidine in patient controlled intravenous analgesia (PCIA) after total abdominal hysterectomies. Methods: A total of 60 patients were randomized to receive either Tramadol or Pethidine by PCIA (30 in each group) after total abdominal hysterectomy. Pain assessments were recorded one hour after starting the PCIA and then at 6, 12, and 24 hours by using visual analogue scale (VAS). Nausea vomiting score and sedation score were also recorded. Good attempts, total attempts and total drug consumption was noted from PCIA pump at the end of the study period. Results: The analgesia achieved in Tramadol group was comparable to Pethidine. The incidence of nausea and vomiting was similar in both groups. Tramadol causes significantly less sedation than Pethidine (p < 0.05). Mean drug consumption, total attempts and good attempts were also significantly less in Tramadol group than Pethidine group (p < 0.05). Conclusion: Tramadol produces equivalent analgesia and less sedation and can be used as an alternative to Pethidine in Patient Controlled Intravenous Analgesia for postoperative pain relief after Total Abdominal Hysterectomy (TAH) (JPMA 56:433;2006). Introduction Despite constantly increasing understanding of pain mechanisms and improved technology in pain therapy, the provision of adequate postoperative pain relief is still a challenge. Adequate pain control improves recovery from surgery by reducing stress and by avoiding pulmonary complications.1 Patient Controlled Intravenous Analgesia (PCIA) has become an established technique for the treatment of postoperative pain.2 It has been shown to offer a number of advantages including good analgesia, avoidance of fluctuations in analgesia level, lower total analgesic dosage, and improved patient satisfaction.3 The typical side-effects of opioids, such as nausea and vomiting, sedation, respiratory depression, and pruritus may sometimes hamper the successful application of PCIA.4 Tramadol is a centrally acting analgesic with a low affinity for μ-opioid receptors. In addition, it also inhibits the neuronal reuptake of noradrenaline and 5-hydroxytryptamine (5-HT) and it facilitates 5-HT release. The advantages of Tramadol over traditional opioids are minimal potential for tolerance, addiction and respiratory depression.5 Tramadol has lack of gastrointestinal side-effects and its reduced incidence of constipation (compared with other opioids) gives it great value for prolonged use.6 Morphine and Pethidine are the most commonly used dugs in PCIA. Unfortunately, both these drugs are not freely available in Pakistan. This double blind, randomized controlled trial was designed to compare efficacy and side effects between Tramadol and Pethidine in PCIA after total abdominal hysterectomies. Patients and Methods The study was performed at a University Hospital after approval from Ethics Review Committee and after informed consent from the patients. The study included 60 ASA I-II patients (30 in each group) with ages of 40 to 60 years undergoing total abdominal hysterectomy who were randomly assigned to one of the group: group A (Tramadol) and group B (Pethidine). The exclusion criteria were contraindications to opioid drugs, inability to understand the instructions because of language barrier, history of substance abuse, severe respiratory disease and patients on Monoamine Oxidase Inhibitors (MAO). All patients were premedicated with midazolam 7.5 mg orally 45-60 minutes prior to induction of anaesthesia with Pethidine 1mg/kg. Thiopental 5 mg/kg and atracurium 0.5 mg/kg was administered to facilitate tracheal intubation. Anaesthesia was maintained with isoflurane 1-1.5% in a mixture of 60% nitrous oxide and 40% oxygen. Routine monitoring done with electrocardiogram, NIBP (Non Invasive Blood Pressure), Pulse oximetry, Capnography (ETCO2), FIO2 and inhalational anaesthetic concentration were used in every patient. At the end of surgery, residual neuromuscular blockade was antagonized by 2.5 mg neostigmine and 1 mg atropine. All patients were given metoclopramide 10mg intravenous 20 minutes before the end of surgery. In the recovery room, PCIA pump (Graseby 3300) was connected to the patient through a separate intravenous line. The PCIA drug solution contained either Tramadol (group A) 10 mg/ml or Pethidine (group B) 10 mg/ml (labeled as PCIA drug). The PCIA pump was programmed to deliver a continuous (basal) infusion of study drug 10mg/hr, bolus dose 5 mg (0.5 ml) with a lockout period of 10 minutes in each group. A second intravenous line was used for maintaining fluids. Pain assessment was done and recorded by primary investigator 1 hour after the start of PCIA and then at 6, 12, and 24 hours by using visual analogue scale (0-10). Nausea vomiting score7 assessed and recorded by using a scale of 03: (0=no nausea vomiting; 1=mild, no treatment needed; 2=moderate, treatment needed and 3=severe; unresponsive to simple antiemetics). Sedation score7 was assessed by using a scale of 0-3: (0=patient awake; 1=mild, occasionally drowsy but easy to rouse; 2=moderate, frequently drowsy and easy to rouse and 3=severe, difficult to rouse, unrousable. Numbers of attempts which include total attempts and good attempts and total drug consumption at the end of study period (at 24 hrs) were also noted from PCIA pump. Total attempts are number of clicks on PCIA remote made by the patient. Good attempts are those clicks in which patient gets the bolus dose. Data was entered and analyzed, using SPSS (Statistical Package for Social Sciences version 13.0).8 Pain score of the two groups were analyzed by using repeated measures ANOVA. The P values at specific time points in nausea vomiting score and sedation score were analyzed by Mann-Whitney U-test. The overall P value for nausea vomiting score and sedation score were analyzed by proportional odds model for repeated ordinal data. Number of attempts and total drug consumption were analyzed by student's ttest. P value < 0.05 was considered as significant." @default.
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• W2162746864 date "2005-09-01" @default.
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• W2162746864 title "Comparison between tramadol and pethidine in patient controlled intravenous analgesia (PCIA)" @default.
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• W2162746864 doi "https://doi.org/10.1016/j.rapm.2005.07.117" @default.
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