Pre-versus postoperative tramadol instillation: both are effective for decreasing pain and/or agitation in pediatric adenotonsillectomy

Authors: GÜLÇİN AYDIN, ALPARSLAN APAN, EMİNE ARZU KÖSE, GÖKŞEN ÖZ

Abstract: The present study aimed to investigate the possible influence of nasopharyngeal preoperative or postoperative tramadol instillation on postoperative pain and agitation in pediatric patients undergoing adenoidectomy, with or without tonsillectomy and tube placement. Materials and methods: Ninety pediatric patients were included in the study. Induction of anesthesia was achieved with 2.5 mg kg^{-1} propofol and 0.6 mg kg^{-1} rocuronium bromide. To maintain the anesthesia, 2%-2.5% sevoflurane in an oxygen-N2O mixture (FiO_2 = 35%) was administered. In Group I (n = 30), 1 mg kg^{-1} tramadol was given 10 min before adenoidectomy, and in Group II (n = 30) it was administered 10 min after adenoidectomy was achieved on the adenoid tissue. Saline, at the same volume, was injected as a control in Group III (n = 30). Patients were evaluated for postoperative pain, agitation score, and modified Aldrete score (MAS) in recovery. Results: When compared with the treatment groups, pain scores and analgesic requirements in the control group significantly increased (P < 0.001). Agitation scores were also significantly higher in the same group. Time-related MASs were significantly lower in the control group in the early recovery period. Conclusion: Preoperative or postoperative tramadol instillation administered to the adenoidectomy area significantly decreased postoperative analgesic requirements and agitation.

Keywords: General anesthesia, sevoflurane, agitation, tramadol

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