Volume 8, Issue 2, December 2020, Page: 30-36
An Audit of Perioperative Use of Tramadol in Children in a Specialized Children Hospital
Ahmed Haroun Mahmoud, Pediatric Anesthesia Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
Mohamed Hanafi Mahmoud, Pediatric Anesthesia Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia; Department of Anesthesia and Intensive Care, Ain Shams University, Cairo, Egypt
Abdulaleem Alatassi, Pediatric Anesthesia Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia; Department of Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Mohamed Ibrahim Emam, Pediatric Anesthesia Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia; Department of Anesthesia and Intensive Care, Cairo University, Cairo, Egypt
Ahmed Mahran Hamada, Pediatric Anesthesia Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
Marwan Hadaki, Pediatric Anesthesia Department, King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia
Zainab Alzayer, Department of Anesthesia, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Badar Alhasani, Department of Anesthesia, Armed Forces Medical Services, Muscat, Sultanate of Oman
Abdulrahman Aljamous, Department of Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Husam I. Ardah, Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Biostatistics and Bioinformatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Received: May 24, 2020;       Accepted: Jun. 8, 2020;       Published: Jun. 16, 2020
DOI: 10.11648/j.ijacm.20200802.11      View  100      Downloads  19
Abstract
Background: Tramadol is widely used worldwide to treat moderate to severe pain in children. There are growing concerns regarding the safety of tramadol use in children in recent years when the US FDA (Food and Drug Administration) issued a safety announcement that restricts tramadol use in children less than 18 years old to treat pain after tonsillectomy and adenoidectomy. After this FDA announcement, our hospital stopped using tramadol in children less than 18 years old. Objective: we planned to audit our experience in the use of intravenous tramadol in children for postoperative pain management in recovery area. Methods: Institutional Review Board (IRB) waived written informed consent. After getting the IRB approval, we reviewed the anesthesia records of 16130 patients between the years 2015 and 2017. We looked for patients who received tramadol postoperatively in PACU (post-anesthesia care unit). We looked for postoperative complications or adverse events in the form of apnea, hypopnea, bradycardia, postoperative nausea and vomiting, prolonged stay in recovery, unplanned admission, or admission after discharge within 48 hours. Statistical analysis was done using Wilcoxon scores for variables, Wilcoxon 2 sample test, calculated odd's Ratio and 95% confidence interval and P-values where P values less than 0.05 were considered significant. Results: Seven patients desaturated out of 430 patients. They needed oxygen support in the form of simple facemask or nasal cannula but no one needed positive pressure ventilation. No one developed apnea or bradycardia or needed naloxone administration. There was no readmission after discharge from the hospital. There was only one unplanned admission due to a surgical cause. The average duration of stay in the PACU was 86 minutes. Almost all (418) patients stayed more than 45 min (97.2%). Ninety-two patients had PONV (postoperative nausea and vomiting) (21.39%). There was positive correlation between PONV and total tramadol dose, while a comparison of the Pearson correlations showed that duration of the procedure was the best predictor of PACU duration with an R-value of 0.188 which was highly significant at the P<0.0001. Conclusion: Tramadol does not cause respiratory depression in children, especially when given in a controlled and monitored setup in the operating room and recovery area however Still, Tramadol needs to be studied more in pediatric anesthesia and analgesia and more comparative data is required to determine the safety of available opioids in this setting.
Keywords
Intravenous Tramadol, Peri-operative Pain, Pediatric Anesthesia, Postoperative Analgesia
To cite this article
Ahmed Haroun Mahmoud, Mohamed Hanafi Mahmoud, Abdulaleem Alatassi, Mohamed Ibrahim Emam, Ahmed Mahran Hamada, Marwan Hadaki, Zainab Alzayer, Badar Alhasani, Abdulrahman Aljamous, Husam I. Ardah, An Audit of Perioperative Use of Tramadol in Children in a Specialized Children Hospital, International Journal of Anesthesia and Clinical Medicine. Vol. 8, No. 2, 2020, pp. 30-36. doi: 10.11648/j.ijacm.20200802.11
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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