Ketorolac vs. tramadol for pain management after abdominal surgery in children

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Paediatrica Indonesiana

VOLUME 54 March NUMBER 2

Original Article

118Paediatr Indones, Vol. 54, No. 2, March 2014

Ketorolac vs. tramadol for pain management after

abdominal surgery in children

Iman Hendarman1_{, Silvia Triratna}1_{, Muhammad T. Kamaludin}2_{, Theodorus}3

Abstract

Background Tramadol is a pure analgesic widely used for

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inflammation drug (NSAID), is widely used in adults and has up

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Objective To compare the clinical efficacies of intravenous

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Methods$GRXEOHEOLQGFRQWUROOHGWULDOZDVFRQGXFWHGLQ0RK +RHVLQ+RVSLWDO3DOHPEDQJIURP-DQXDU\WR-XQH6XEMHFWV ZHUHSRVWRSHUDWLYHFKLOGUHQDJHG\HDUVZKRPHWWKHLQFOXVLRQ FULWHULD 7KH\ ZHUH UDQGRPL]HG LQWR WZR JURXSV ZKR UHFHLYHG HLWKHU LQWUDYHQRXV NHWRURODF RU WUDPDGRO 6XEMHFWV DVVHVVHG

their pain level using the Face, Legs, Arms, Cry and Consolability

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Results2IWKHVXEMHFWVZKRXQGHUZHQWDEGRPLQDOVXUJHU\ZLWK JHQHUDODQHVWKHVLDZHUHER\VDQGZHUHJLUOV 6XEMHFWV·PHDQDJHDQGERG\ZHLJKWZHUH6'\HDUVDQG 6'NJUHVSHFWLYHO\0HDQGXUDWLRQRIVXUJHU\ZDV 6'PLQXWHVDQGPHDQSRVWRSHUDWLYH)/$&&VFRUHZDV 6'(LJKWVXEMHFWVGURSSHGRXWRIWKHVWXG\(IILFDFLHVRI NHWRURODFDQGWUDPDGROZHUHQRWVLJQLILFDQWO\GLIIHUHQWDWDQG UHVSHFWLYHO\3 ,QDGGLWLRQWKHUHZDVQRVLJQLILFDQW GLIIHUHQFHLQWKHQXPEHURISDWLHQWVH[SHULHQFLQJD!)/$&& VFRUHGHFOLQHEHWZHHQNHWRURODFDQGWUDPDGROJURXSV3

Conclusion There is no significant difference in the efficacies

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Keywords: intravenous, ketorolac,tramadol, FLACC

From the Department of Child Health, Clinical Pharmacology Unit2_{, and}

the Biostatistics and Epidemiology Unit, Sriwijaya University Medical

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Reprint requests to: Iman Hendarman, Department of Child Health,

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A

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pain and do not receive adequate pain

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adequate analgesics may minimize and prevent complications caused by pain, help the patient feel comfortable, and reduce morbidity and mortality

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Tramadol has been used as a postoperative analgesic and is well tolerated in neonates and

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the clinical efficacy of tramadol as an analgesic was

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The purpose of this study was to compare the clinical efficacies of intravenous ketorolac and

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Iman Hendarman et al: .HWRURODFYVWUDPDGROIRUSDLQPDQDJHPHQWDIWHUDEGRPLQDOVXUJHU\

Paediatr Indones, Vol. 54, No. 2, March 2014119

Methods

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dysfunction, peptic ulcers, as well as those who used tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI), monoamine oxide inhibitors (MAOI), antipsychotics, acetylsalicylic acid, oxpentafylline, probenecid, lithium salt, heparin,

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have dropped out of the study if they experienced loss

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Subjects were randomly assigned to 2 groups

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performed after the subject regained consciousness

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Subjects in group I received 2mg/kg body weight intravenous tramadol every 6 hours, while those in

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Data was analyzed using the SPSS program

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Table 1._{Characteristics of subjects by analgesic group (n=52)}

Characteristics Ketorolac group

(n=26)

Tramadol group (n=26) Gender, n

Ŗ/CNGU 14 14

Ŗ(GOCNGU 12 12

Mean age (SD), years

Ŗ Ō[GCTUQNF 2.3 (1.07) 2.5 (0.92)

Ŗ Ō[GCTUQNF 5.4 (0.3) 5.9 (0.53)

Mean body weight (SD), kg 12.3 (2.74) 13 (2.86)

Nutritional status, n

Ŗ 9GNNPQWTKUJGF 5 8

Ŗ 7PFGTPQWTKUJGF 21 18

Indications for abdominal surgery, n

Ŗ +PVTCCDFQOKPCNVWOQT 2 4

Ŗ 2GTHQTCVGFCRRGPFKEKVKU 2 3

Ŗ 8KUEGTCNTWRVWTG 4 5

Ŗ +PECTEGTCVGFKPIWKPCNJGTPKC 5 5

Ŗ 1DUVTWEVKXGKNGWU 6 4

Ŗ 4GFWEKDNGKPIWKPCNJGTPKC 7 5

Mean duration of surgery, minutes (SD) 71.7 (23.15) 69.6 (19.33) Mean interval between end of surgery and onset of pain

after regaining consciousness (SD), minutes

22.3 (6.36) 22.5 (7.11)

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120Paediatr Indones, Vol. 54, No. 2, March 2014

UHSRUWHG WKDW WUDPDGRO HIILFDF\ ZDV RQO\ 4 However, a study found that intravenous tramadol

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VXEMHFWVDOOXQGHUZHQWVLPLODUVXUJHULHVKHUQLRWRP\6 One limitation of our study was the lack of homogenity in the types of surgery our subjects underwent, some

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more homogenous subjects, in terms of indications for surgery, is needed to limit the variability in degree of

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A previous study showed that there was a significant decline in pain scale score after intravenous

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the decline in FLACC score took a longer time and there was no significant difference in the time required

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might be due to the type of surgery, tonsillectomy in their subjects, with less tissue damage and less induced

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vomiting, or GI bleeding, as well as skin bleeding, petechiae, bradycardia, urinary retention, seizure

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one subject in the ketorolac group experienced GI bleeding, so the analgesic administration was stopped

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and vomiting were observed in 2 subjects in the

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Gastrointestinal tract complaints in our tramadol group were more frequent than in Barsoum’s study which

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In conclusion, there is no significant difference between intravenous ketorolac and intravenous

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References

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This study was approved by the Board of Ethics of Sriwijaya University Medical School and subjects’

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Results

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to another hospital (2 children), or gastrointestinal hemorrhage before completing 4 doses of analgesic

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group are shown in Table 1.

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was not significantly different between the two groups

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Rescue analgesic was given to 5/26 children in

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Based on the need for rescue analgesics, ketorolac and

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the subjects, respectively, not a statistically significant

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At 2 hours after drug administration there were

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Mean baseline pain scores in the ketorolac and

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Paediatr Indones, Vol. 54, No. 2, March 2014121

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effect of intravenous ketorolac versus tramadol in pediatric

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