ANALGESIC EFFICACY OF TRAMADOL IN PEDIATRIC TONSILLECTOMY WITH ADENOIDECTOMY

Background: Tonsillectomy is one of the most commonly performed surgical prcedures in childhood. Acute pain after tonsillectomy and adenoidectomy can be treated with non-opioid and opioid analgesics. Our hypothesis stated that tramadol iv after induction of anaesthesia has superior analgesic effect compared to acetaminophen. Methods: In a prospective, randomised study we compared analgesic efficacy of tramadol (group T: 2 mg/kgBW iv) and acetaminophen (group A: elixir 15 mg/kgBW before op. procedure) in a group of 108 children (age 3-7 years). Exclusion critheria: allergy, liver or kidney failure, epilepsy, febrile convulsions. A standard anaesthetic technique was used: propofol, alfentanil, vecuronium, positive pressure ventilation with 60% nitrous oxide in oxygen. After the procedure each child received acetaminophen suppositories (10 mg/kgBW/4-6h) and combined suppositories. Monitoring: vital signs during and after op. procedure, pain intensity on the ward (facial pain score).   Results: There were no significant differences between the two groups in age distribution (mean age 5,2 years), ASA physical status, body weight, operative procedure, pain scores (VAS 6h after operative procedure; group T: 4,21±1,45; group A: 4,06±1,33), oxygen saturation, pulse frequency and the consumption of acetaminophen suppositories. Significant difference was in the consumption of combined suppositories (group T: 1,85±0,79; group A: 1,43±0,69, p=0,003).  Conclusion: Our study has shown, that tramadol is not a superior analgesic for the relief of posttonsillectomy pain in children compared to acetaminophen.