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Tramadol 2.5 mg·kg^-1 appears to be the optimal intraoperative loading dose before patient-controlled analgesia

[Une dose de 2,5 mg·kg^-1 de tramadol semble la dose d’attaque peropératoire optimale avant l’analgésie auto-contrôlée]

Wei-Wu Pang, MD^*, Hurng-Sheng Wu, MD and Chien-Chiung Tung, MD

^* From the Department of Anesthesia,
Show-Chwan Memorial Hospital Changhua The Department Of Surgery,
Show-Chwan Memorial Hospital Changhua National Defense Medical Center Tri-service General Hospital Taipei The Department Of Anesthesia Chen-Ching Hospital Wu-Fong Taichung 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: We previously established that a 5 mg•kg^-1 intraoperative dose can reduce the nausea/vomiting associated with tramadol patient-controlled analgesia (PCA). This study was conducted to identify the most appropriate initial dose to improve the quality of tramadol PCA.

Methods: During general anesthesia, 60 patients undergoing knee arthroplasty were randomly allocated to receive 1.25 mg•kg^-1 (Group I), 2.5 mg•kg^-1 (Group II), 3.75 mg•kg^-1 (Group III), or 5 mg•kg^-1 (Group IV) tramadol. The emergence condition was recorded. The titration of additional tramadol 20 mg + metoclopramide 1 mg doses by PCA every five minutes was performed in the postanesthesia care unit (PACU) until the visual analogue scale (VAS) score was # 3. An investigator blinded to study group recorded the VAS and side effects every ten minutes.

Results: In the PACU, significantly more tramadol (8.4 ± 3.1 vs 4.3 ± 2.1, 2.5 ± 1.8, and 0.4 ± 0.3, P < 0.05), and a higher incidence (15/15 vs 5/15, 3/15, and 2/15, P < 0.05) of PCA use was observed in Group I compared to Groups II–IV. VAS was significantly higher in Group I than in Groups II–IV at zero and ten minutes (P < 0.05). Unexpected delayed emergence anesthesia (> 30 min) was observed in Group III (n = 1) and in Group IV (n = 2). Sedation was more important in Groups III and IV than in Groups I and II (P < 0.05).

Conclusion: When considering efficacy and side-effect profile, 2.5 mg•kg^-1 of tramadol is the optimal intraoperative dose of this drug to provide effective postoperative analgesia with minimal sedation.

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