Erkan Tomatir

Effects of low dose ketamine before induction on propofol anesthesia for pediatric magnetic resonance imaging

Background : We aimed to investigate effects of low dose ketamine before induction on propofol anesthesia for children undergoing magnetic resonance imaging (MRI).

The addition of droperidol or clonidine to epidural tramadol shortens onset time and increases duration of postoperative analgesia

PurposeTo compare tramadol alone and the combinations of either tramadol-clonidine or tramadol-droperidol with regard to analgesic and adverse effects.MethodsAfter Ethics Committee approval and patient informed consent were obtained, epidural catheters were inserted preoperatively at the L3–4 interspace in 90 ASA physical status I–II adult patients undergoing lower abdominal surgery. Anesthesia was standardized. Patients were randomly assigned to one of three groups. Group I (T) patients received tramadol 75 mg, Group II (TD) patients received tramadol 75 mg plus droperidol 2.5 mg, and Group III (TC) patients received tramadol 75 mg plus clonidine 150 μg in a total volume of 10 mL administered as a single epidural injection in the postanesthesia care unit. The onset time of analgesia and duration of analgesia, visual analogue pain scores, sedation, nausea scores, vital signs and side effects were recorded.ResultsDuration of analgesia was similar in both the TD and TC groups, and significantly longer than in the T group (P < 0.001). Group TC patients displayed a significant increase in sedation scores and decrease in blood pressure and heart rate when compared with other groups (P < 0.001). No adverse effects were observed in Group TD, while nausea scores were high in both the T and TC groups (P < 0.001), Pain score, respiration rate, and SpO2 values were similar in all study groups.ConclusionWe conclude that epidural tramadol in combination with droperidol or clonidine prolongs the duration of analgesia; however, droperidol appears to be a better alternative when adverse effects and antiemetic properties are taken into consideration.RésuméObjectifComparer ie tramadol à la combinaison de tramadol-clonidine ou de tramadol-dropéridol en regard de leurs effets analgésiques et indésirables.MéthodeAyant obtenu l’approbation du Comité d’éthique et le consentement éciairé des patients, nous avons réalisé l’insertion préopératoire d’un cathéter péridural dans l’espace intercostal L3–4 chez 90 patients adultes d’état physique ASA I–II devant subir une intervention abdominale basse. Lanesthésie a été normalisée. Les patients ont été répartis en trois groupes de façon aléatoire. Ceux du groupe I (T) ont reçu 75 mg de tramadol, ceux du groupe II (TD), 75 mg de tramadol et 2,5 mg de dropéridol et du groupe III (TC), 75 mg de tramadoi plus 150 μg de clonidine dans un volume total de 10 mL administré à la salle de réveil en une seule injection péridurale. Le délai d’installation et la durée de l’analgésie, la douleur selon l’échelle visuelle analogique, la sédation, les nausées, les signes vitaux et les effets secondaires ont été notés.RésultatsLa durée de l’analgésie a été comparable entre les groupes TD et TC et signifcativement plus longue que dans le groupe T (P < 0,001). Les patients du groupe TC, comparés à ceux des autres groupes, ont connu une hausse signifcative des scores de sédation et une baisse de la tension artérielle et de la fréquence cardiaque (P < 0,001). Aucun effet indésirable n’a été observé dans le groupe TD tandis que les scores de nausées ont été plus élevés dans les groupes T et TC (P < 0,001). Les scores de douleur, la fréquence respiratoire et la SpO2 ont présenté des valeurs similaires dans tous les groupes de l’étude.ConclusionNous pouvons conclure que l’administration péridurale de tramadol, combinée au dropéridoi ou à la clonidine, prolonge la durée de l’analgésie; cependant, le dropéridoi semble un meilleur choix quand on considère les effets indésirables et les propriétés antiémétiques.

Tramadol Versus Low Dose Tramadol-paracetamol for Patient Controlled Analgesia During Spinal Vertebral Surgery

Pain intensity may be high in the postoperative period after spinal vertebral surgery. The aim of the study was to compare the effectiveness and cost of patient controlled analgesia (PCA) with tramadol versus low dose tramadol‐paracetamol on postoperative pain. A total of 60 patients were randomly divided into two groups. One group received 1.5 mg/kg tramadol (Group T) while the other group received 0.75 mg/kg tramadol plus 1 g of paracetamol (Group P) intravenously via a PCA device immediately after surgery and the patients were transferred to a recovery room, Tramadol was continuously infused at a rate of 0.5 mL/h in both groups, at a dose of 10 mg/mL in Group T and 5 mg/mL in Group P. The bolus and infusion programs were adjusted to administer a 1 mL bolus dose of tramadol with a lock time of 10 minutes. In Group P, 1 g of paracetamol was injected intravenously every 6 hours. The four‐point nausea scale, numeric rating scale for pain assessment, Ramsey sedation scale, blood pressure, heart rate, respiration rate, peripheral oxygen saturation values and side effects were recorded at 0, 15 and 30 minutes, and at 1, 2, 4, 6, 12, 18 and 24 hours. The time to reach an Aldrete score of 9 was also recorded. A cost analysis for both groups was performed. In Group P, the numeric rating scale scores were significantly lower than that in Group T at 0 and 15 minutes. The number of side effects, additional analgesic requirement and the total dose of tramadol were lower in Group P than in Group T. However, the total cost of postoperative analgesics was significantly higher in Group P than in Group T (p < 0.001). We conclude that PCA using tramadol‐paracetamol could be used safely for postoperative pain relief after spinal vertebral surgery, although at a higher cost than with tramadol alone.