Comparison of the postoperative analgesic efficacy of intravenous patient-controlled analgesia with tramadol to intravenous patient-controlled analgesia with opioids
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA. Journal of opioid management
03/2010; 6(2):141-7. DOI: 10.5055/jom.2010.0014
Intravenous patient-controlled analgesia (IV PCA) with tramadol is an accepted method to deliver postoperative analgesia outside North America; however, the analgesic efficacy of this analgesic agent when compared with IVPCA with opioids is uncertain. As such, the authors undertook a systematic review to compare the analgesic efficacy of IVPCA tramadol with that of IVPCA with opioids.
The authors used the National Library of Medicine's Medline database to search for terms related to tramadol and patient-controlled analgesia. Inclusion criteria were randomized controlled trials (RCTs) comparing IVPCA tramadol with IVPCA opioid and RCTs published in the English language. Relevant data were abstracted from accepted studies. Meta-analysis was performed using RevMan 4.2.10 (The Cochrane Collaboration, 2004). A random effects model was used.
A total of 190 abstracts were obtained from the above search, and a total of 12 RCTs met the above inclusion criteria. There was no difference in weighted visual analog scale pain scores between IVPCA tramadol versus IVPCA opioid at 48 hours postoperatively or risk of sedation or fatigue. IVPCA tramadol was associated with a higher odds of postoperative nausea and vomiting [odds ratio (OR) = 1.52, 95% confidence interval (CI) = 1.07-2.14) but a lower odds of pruritus (OR = 0.43, 95% CI = 0.19-0.98).
IVPCA tramadol appears to produce similar pain scores when compared with that from IVPCA opioids; however, the side effect profile is different between the two groups. Because of the relatively small sample size, no determination of the relative "safety" (eg, respiratory depression) of one regimen over the other can be made, and larger RCTs would be needed for such a determination.
Available from: PubMed Central
- "Bromage scores were good except for 5 participants (4 in CFNB group and 1 in PCIA group). For participants in PCIA group, nonopioid medications (tramadol and NSAID) were used; several large-sampled meta-analyses have demonstrated that tramadol could attain satisfactory analgesic effects with well-organized acute pain service . The major adverse events associated with nonopioid medications were nausea and vomiting ; therefore, a combined prevention regimen with ondansetron and dexamethasone was used. "
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ABSTRACT: Objectives. To evaluate the comparative analgesia effectiveness and safety of postoperative continuous femoral nerve block (CFNB) with patient controlled intravenous analgesia (PCIA) and their impact on knee function and chronic postoperative pain. Methods. Participants were randomly allocated to receive postoperative continuous femoral nerve block (group CFNB) or intravenous patient controlled analgesia (group PCIA). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for knee and incidence of chronic postoperative pain at 3, 6, and 12 months postoperatively were compared. postoperative pain and salvage medication at rest or during mobilization 24 hours, 48 hours, and 7 days postoperatively were also recorded. Results. After discharge from the hospital and rehabilitation of joint function, patients in group CFNB reported significantly improved knee flexion and less incidence of chronic postoperative pain at 3 months and 6 months postoperatively (P < 0.05). Analgesic rescue medications were significantly reduced in patients receiving CFNB (P < 0.001 and P = 0.031, resp.). Conclusion. With standardized rehabilitation therapy, continuous femoral nerve block analgesia reduced the incidence of chronic postoperative pain, improved motility of replaced joints, and reduced the dosages of rescue analgesic medications, suggesting a recovery-enhancing effect of peripheral nerve block analgesia.
Available from: Lesley J Smith
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ABSTRACT: To evaluate the effectiveness of topical nalbuphine or oral tramadol in the treatment of corneal pain in dogs.
Fourteen male Beagle dogs.
Dogs were divided into three treatment groups and sedated with dexmedetomidine (5 μ/kg IV). A 4 mm corneal epithelial wound was created in the right eye (OD) of all dogs. Sedation was reversed with atipamazole IM. All dogs received pre/post ophthalmic examinations. Post operatively, Group NB (n = 5) received topical 1% preservative-free nalbuphine OD q8 h and an oral placebo PO q8 h. Group TR (n = 5) received tramadol (4 mg/kg) PO q8 h and topical sterile saline OD q8 h. Group CNTRL (n = 4) received topical sterile saline OD q8 h and an oral placebo q8 h. All dogs received topical 0.3% gentamicin OD TID until healed. Dogs were pain scored using a pain scoring system modified from the University of Melbourne pain scale at 0, 1, 2, 4, and 6 h, then every 6 h by observers masked to treatment, until corneal wounds were healed. Treatment failure was recorded if cumulative pain scores were above a minimum threshold of acceptable pain and rescue analgesia of morphine (1.0 mg/kg IM) was administered subsequently.
Four dogs in Group NB, one dog in Group TR, and two dogs in Group CNTRL required rescue analgesia. There was no significant difference in the incidence of treatment failure between groups (P = 0.184). Mean time to rescue was 9.16 h. All corneal wounds were healed by 84 h.
The results of this study suggest tramadol rather than nalbuphine should be further investigated for the treatment of corneal pain.
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ABSTRACT: IntroductionOne of the major drawbacks of posterior cervical decompression and rigid internal fixation is the severe postoperative neck pain created by extensive soft tissue and muscular dissection. The usual management of acute postsurgical pain consists of systemic opioids or non-steroidal anti-inflammatory drugs. Another satisfying method of postoperative pain relief is continuous local infusion of analgesic agents in posterior subfascial paravertebral space on both sides of the wound using epidural catheters.Methods
Sixty patients scheduled for cervical laminectomy with fixation surgery via the posterior midline approach with postoperative epidural catheters placed subfascially on both sides of the wound. They were randomly divided into two groups, bupivacaine group with local infiltration of 0.5% bupivacaine at the rate 2 ml/h, and control group with saline infusion at a rate 2 ml/h. The patient controlled analgesia device (PCA) was given to all patients and set to deliver IV morphine in 1 mg boluses with a lock out at 10 min and a 4 h maximum 10 mg.ResultsThe visual analog score was statistically significant lower in bupivacaine group compared to control group during the first 60 h postoperatively. While in 66 and 72 h postoperatively there was no statistical significant difference was observed between the two groups. The total doses of morphine delivered by PCA in the three postoperative days were statistically significantly higher in control group than bupivacaine group. The incidence of side effects related to narcotics was higher in control than bupivacaine group.Conclusion
Bilateral subfascial continuous 0.5% bupivacaine infiltration through an ordinary epidural catheter at the rate 2 ml/h for three successive postoperative days is associated with better pain control, reduced narcotics, early ambulation and no serious side effects in the postoperative period in patients undergoing posterior cervical fixation.
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