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Addition of remifentanil to patient-controlled tramadol for postoperative analgesia: a double-blind, controlled, randomized trial after major abdominal surgery

Published online by Cambridge University Press:  01 December 2008

H. Unlugenc ,
S. Tetiker  and
G. Isik
H. Unlugenc*
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anesthesiology, Adana, Turkey
S. Tetiker
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anesthesiology, Adana, Turkey
G. Isik
Affiliation:
Cukurova University, Faculty of Medicine, Department of Anesthesiology, Adana, Turkey
*
Correspondence to: Hakki Unlugenc, Department of Anaesthesiology, Faculty of Medicine, Cukurova University, 01330 Adana, Turkey. E-mail: unlugenc@cu.edu.tr; Tel: +90 322 3386742; Fax: +90 322 3386742
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Summary

Background and objective

We have investigated whether, after major abdominal surgery, the addition of remifentanil to tramadol for intravenous patient-controlled analgesia improved analgesia and lowered pain scores, compared to a patient-controlled analgesia containing only tramadol.

Methods

Sixty-two patients were allocated randomly to receive an intravenous patient-controlled analgesia with tramadol alone (T), or tramadol plus remifentanil (TR), in a double-blind randomized study. Whenever patients complained of pain, they were allowed to use bolus doses of tramadol (0.2 mg kg−1) or tramadol (0.2 mg kg−1) plus remifentanil (0.2 μg kg−1) mixture every 10 min without a time limit and background infusion. Discomfort, sedation, pain scores, total and bolus patient-controlled analgesia tramadol consumption, and side-effects were recorded for up to 24 h after the start of patient-controlled analgesia.

Results

Pain scores at rest were statistically significantly lower in the TR group at 6, 12 and 24 h than in T group (P < 0.05). Pain scores at movement and patient comfort scores were also found to be significantly lower in the TR group at 2, 6, 12 and 24 h than in the T group (P < 0.05). Although the TR group consumed less tramadol, there were no statistically significant differences in the cumulative tramadol consumptions between the groups at any time. However, the number of patients requiring rescue analgesia and average supplementary doses used was significantly higher in the T group than in the TR group (P < 0.05).

Conclusions

After major abdominal surgery, adding remifentanil (0.2 μg kg−1) to tramadol (0.2 mg kg−1), with 10-min lockout times, for patient-controlled analgesia offered better postoperative pain relief and patient comfort, without causing any sedation or respiratory depression.

Keywords

PAIN ACUTE AND POSTOPERATIVEREMIFENTANILTRAMADOLPATIENT-CONTROLLED ANALGESIASURGERY ABDOMINAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 12 , December 2008 , pp. 968 - 975
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1.Scott, DA, Chamley, DM, Money, PH, Deam, RK, Mark, AH, Hagglof, B. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery – a dose finding study. Anesth Analg 1995; 81: 982–986.Google ScholarPubMed
2.Niiyama, Y, Kawamata, T, Shimizu, H, Omote, K, Namiki, A. The addition of epidural morphine to ropivacaine improves epidural analgesia after lower abdominal surgery. Can J Anesth 2005; 52: 181–185.CrossRefGoogle ScholarPubMed
3.Pouzeratte, Y, Delay, JM, Brunat, G et al. Patient-controlled epidural analgesia after abdominal surgery: ropivacaine versus bupivacaine. Anesth Analg 2001; 93: 1587–1592.CrossRefGoogle ScholarPubMed
4.Raffa, RB, Clark-Vetri, R, Tallarida, RJ, Wertheimer, AI. Combination strategies for pain management. Expert Opin Pharmacother 2003; 4: 1697–1708.CrossRefGoogle ScholarPubMed
5.Duthie, DJR. Remifentanil and tramadol: recent advances in opioid pharmacology. Br J Anaesth 1998; 81: 51–57.CrossRefGoogle Scholar
6.Rose, JB, Finkel, JC, Arquedas-Mohs, A, Himelstein, BP, Schreiner, M, Medve, RA. Oral tramadol for the treatment of pain of 7–30 days’ duration in children. Anesth Analg 2003; 96: 78–81.Google ScholarPubMed
7.Egan, TD. Remifentanil pharmacokinetics and pharmacodynamics, a preliminary appraisal. Clin Pharmacokinet 1995; 29: 80–94.CrossRefGoogle ScholarPubMed
8.Bilotta, F, Caramia, R, Paoloni, FP et al. Early postoperative cognitive recovery after remifentanil–propofol or sufentanil–propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol 2007; 24: 122–127.CrossRefGoogle ScholarPubMed
9.Kapila, A, Glass, PS, Jacobs, JR et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–975.CrossRefGoogle ScholarPubMed
10.Karabinis, A, Mandragos, K, Stergiopoulos, S et al. Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomized, controlled trial. Crit Care 2004; 8: 268–280.CrossRefGoogle Scholar
11.Lang, E, Kapila, A, Shlugman, D, Hoke, JF, Sebel, PS, Glass, PSA. Reduction of isoflurane minimal alveolar concentration by remifentanil. Anesthesiology 1996; 85: 721–728.CrossRefGoogle ScholarPubMed
12.Bouillon, TW, Bruhn, J, Radulescu, L et al. Pharmacodynamic interaction between propofol and remifentanil regarding hypnosis, tolerance of laryngoscopy, bispectral index, and electroencephalographic approximate entropy. Anesthesiology 2004 ; 100: 1353–1372.CrossRefGoogle ScholarPubMed
13.Webb, AR, Leong, S, Myles, PS, Burn, SJ. The addition of a tramadol infusion to morphine patient-controlled analgesia after abdominal surgery: a double-blinded, placebo-controlled randomized trial. Anesth Analg 2002; 95: 1713–1718.CrossRefGoogle ScholarPubMed
14.Raffa, RB, Friderichs, E, Reimann, W, Shank, RP, Codd, EE, Vaught, JL. Opioid and nonopioid components independently contribute to the mechanism of action of tramadol, an ‘atypical’ opioid analgesic. J Pharmacol Exp Ther 1992; 260: 275–285.Google Scholar
15.Raffa, RB, Friderichs, E, Reimann, W et al. Complementary and synergistic antinociceptive interaction between the enantiomers of tramadol. J Pharmacol Exp Ther 1993; 267: 331–340.Google ScholarPubMed
16.Stiller, CO, Lundblad, H, Weidenhielm, L et al. The addition of tramadol to morphine via patient-controlled analgesia does not lead to better post-operative pain relief after total knee arthroplasty. Acta Anaesthesiol Scand 2007; 51: 322–330.CrossRefGoogle Scholar
17.Collier, HO, Dinneen, LC, Johnson, C, Schneider, C. The abdominal constriction response and its suppression by analgesic drugs in the mouse. Br J Pharmacol 1968; 32: 295–310.Google ScholarPubMed
18.Schüttler, J, Albrecht, S, Breivik, H et al. A comparison of remifentanil and alfentanil in patients undergoing major abdominal surgery. Anaesthesia 1997; 52: 307–317.CrossRefGoogle ScholarPubMed
19.Lehmann, KA. Tramadol in acute pain. Drugs 1997; 53 (Suppl 2): 25–33.CrossRefGoogle ScholarPubMed
20.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.CrossRefGoogle ScholarPubMed
21.Montes, A, Warner, W, Puig, MM. Use of intravenous patient controlled analgesia for the documentation of synergy between tramadol and metamizol. Br J Anaesth 2000; 85: 217–223.Google ScholarPubMed
22.Thurlow, JA, Waterhouse, P. Patient-controlled analgesia in labour using remifentanil in two parturients with platelet abnormalities. Br J Anaesth 2000; 84: 411–413.CrossRefGoogle ScholarPubMed
23.Blain, JM, Hill, DA, Fee, JP. Patient-controlled analgesia for labour using remifentanil: a feasibility study. Br J Anaesth 2001; 87: 415–420.Google Scholar
24.Bowdle, TA, Camporesi, EM, Maysick, L et al. A multicenter evaluation of remifentanil for early postoperative analgesia. Anesth Analg 1996; 83: 1292–1297.CrossRefGoogle ScholarPubMed
25.Greif, R, Laciny, S, Rapf, B, Hickle, RS, Sessler, DI. Supplemental oxygen reduces the incidence of postoperative nausea and vomiting. Anesthesiology 1999; 91: 1246–1252.CrossRefGoogle ScholarPubMed
26.Silvasti, M, Tarkkila, P, Tuominen, M, Svartling, N, Rosenberg, PH. Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. Eur J Anaesthesiol 1999; 16: 834–839.CrossRefGoogle ScholarPubMed
27.Gurbet, A, Goren, S, Sahin, S, Uckunkaya, N, Korfali, G. Comparison of analgesic effects of morphine, fentanyl, and remifentanil with intravenous patient-controlled analgesia after cardiac surgery. J Cardiothorac Vasc Anesth 2004; 18: 755–758.CrossRefGoogle ScholarPubMed