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Metoclopramide decreases emesis but increases sedation in tramadol patient-controlled analgesia

[Le métoclopramide diminue les vomissements, mais augmente la sédation chez des patients qui reçoivent une analgésie auto-contrôlée avec du tramadol]

Wei-Wu Pang, MD^*, Hurng-Sheng Wu, MD, Ching-Hsiung Lin, MD^*, Da-Peng Chang, MD^* and Min-Ho Huang, MD

¹ From the Departments of Anesthesia and
Surgery, Show-Chwan Memorial Hospital Changhua, Taiwan, R.O.C.

Address correspondence to: Dr. Wei-Wu Pang, 7630 Pissarro Dr. Apt # 108, Orlando, Florida 32819, USA. Phone: 407-351-8246; Fax: 407-351-8246; E-mail: sungfangrong{at}aol.com

Purpose: To evaluate the clinical benefits and disadvantages of adding metoclopramide to tramadol for patient-controlled analgesia (PCA).

Methods: Forty adult patients, undergoing elective arthroplasties, were recruited into this prospective, randomized, double-blind study. During general anesthesia all patients received 2.5 mg•kg^-1 of tramadol as a loading dose at the beginning of wound closure. In the postanesthesia care unit (PACU) patients were randomly allocated to receive PCA containing either 20 mg tramadol + 1 mg metoclopramide per millilitre (n = 20, Group T+M) or tramadol 20 mg per millilitre (n = 20, Group T). The PCA setup was 1 mL/bolus with a lockout interval of five minutes. A blinded investigator assessed the vital signs, visual analogue scale, and severity of postoperative nausea and/or vomiting in the PACU. The PCA demand and delivery, overall satisfaction rate and adverse effects were recorded in the PACU and on postoperative days one and two.

Results: Nausea/vomiting scores were more severe (1.7 ± 1.0 vs 0.2 ± 0.5, 2.3 ± 1.2 vs 0.6 ± 0.6, 1.9 ± 0.9 vs 0.2 ± 0.5, at 12 hr, 18 hr, 24 hr, respectively, P < 0.05) and more frequent (7/20 vs 1/20, 5/20 vs 0/20 for nausea and vomiting respectively, P < 0.05) on postoperative day one in Group T compared to Group T+M. However, the incidence of sedation was higher in Group T+M (7/20 vs 1/20, P < 0.05).

Conclusions: The incidence and severity of nausea/vomiting decreased if metoclopramide was added to tramadol for PCA. An increased incidence of sedation was noticed with this drug combination.

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