Titre du document / Document title

Preoperative adjuvant epidural tramadol : The effect of different doses on postoperative analgesia and pain processing

Auteur(s) / Author(s)

WILDER-SMITH C. H. ; WILDER-SMITH O. H. G. ; FARSCHTSCHIAN M. ⁽¹⁾ ; NAJI P. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Anaesthesiology, Klinik am Rosenberg, Heiden, SUISSE
Nociception Research Group, University of Berne, SUISSE
Department of Anaesthesiology, University Hospital Geneva, SUISSE

Résumé / Abstract

Background: Tramadol is an analgesic with combined opioid agonist and monoamine reuptake blocker properties, which may be useful as a perioperative analgesic and antinociceptive adjuvant. Methods: The dose-dependent effects of adjuvant preoperative epidural tramadol on postoperative analgesia (pain scores and patient-controlled analgesia (PCA) use) and pain processing (heat pain thresholds) were prospectively studied in a double-blind, randomised, placebo-controlled 5-day trial. Forty patients undergoing knee or hip surgery received anaesthesia with epidural lidocaine and epidural tramadol 20, 50 or 100 mg or placebo as a preoperative adjuvant. Postoperative analgesia was by intravenous PCA tramadol in all patients. Results: Postoperative pain scores were similar in all groups. The time to first PCA use was shorter, the total dose and duration of PCA use greater, and side-effects more common with 20 mg tramadol than with 100 mg or placebo (P<0.05). There were no differences in PCA doses required or side-effects between the tramadol 100 mg and placebo treatment groups. Heat pain tolerance thresholds were increased with 100 mg tramadol at 48 h postoperatively compared to baseline and placebo (P= 0.01). Conclusions: Preoperative adjuvant epidural tramadol does not improve postoperative analgesia after lidocaine epidural anaesthesia compared to placebo. Tramadol 20 mg results in anti-analgesia and increased side-effects. While tramadol 100 mg depresses postoperative pain-processing, as measured by heat pain tolerance thresholds, this is not reflected in improved clinical pain measures.

Revue / Journal Title

Acta anaesthesiologica scandinavica   ISSN 0001-5172   CODEN AANEAB 

Source / Source

1998, vol. 42, n^o3, pp. 299-305 (32 ref.)

Langue / Language

Anglais

Editeur / Publisher

Blackwell, Oxford, ROYAUME-UNI  (1957) (Revue)

Mots-clés anglais / English Keywords

Tramadol ; Narcotic analgesic ; Extradural administration ; Pain ; Postoperative ; Chemotherapy ; Prevention ; Dose activity relation ; Treatment ; Analgesia ; Orthopedic surgery ; Human ;

Mots-clés français / French Keywords

Tramadol ; Analgésique narcotique ; Voie extradurale ; Douleur ; Postopératoire ; Chimiothérapie ; Prévention ; Relation dose réponse ; Traitement ; Analgésie ; Chirurgie orthopédique ; Homme ;

Mots-clés espagnols / Spanish Keywords

Tramadol ; Analgésico narcotico ; Vía extradural ; Dolor ; Postoperatorio ; Quimioterapia ; Prevención ; Relación dosis respuesta ; Tratamiento ; Analgesia ; Cirugía ortopédica ; Hombre ;

Localisation / Location

INIST-CNRS, Cote INIST : 8878, 35400007873004.0040