Waqar Hassan, Muhammad Inam, Abdul Satar, Mohammad Arif.
Postoperative analgesia with tramadol in orthopedic surgery: continuous infusion versus repetitive bolus administration.
J Surg Pak Jan ;17(4):147-51.

Objective: To compare the effect of infusion of tramadol with repetitive administration of bolus on postoperative pain in orthopedic surgery. Study design: Comparative study. Place & Duration of study: Department of Orthopedics and Spine Surgery Hayatabad Medical Complex Peshawar, form October 2009 to April 2010. Methodology: Patients with American Society of Anesthesia clinical grade I and II, age >18 year scheduled for ambulatory orthopedic and trauma surgery were included. Half of the randomly selected patients were placed in infusion group (Group I) who received an initial intravenous loading dose of 100 mg tramadol followed by an infusion of 12 mg/hour tramadol for 24 hours after recovery from anesthesia; if necessary, repeated bolus of 50 mg tramadol was given. Half of randomly selected patients were in bolus group (Group II).These patients received a placebo infusion instead of tramadol infusion and only received bolus doses of 50 mg on demand. Results: The pain relief was assessed as excellent or good by 78 % of group I and 70 % of group II patients. In group I, 65 % requested only one or no repetitive bolus, compared with 40 % in group II, while two or more bolus were demanded by 30 % in group I and 60 % in group II. The average analgesic consumption after 6 hours was 222 +/- 50 mg tramadol in group I and 200 +/- 50 mg tramadol in group II, respectively. After 24 hours it was 438 +/- 50 mg tramadol in group I and 250 +/- 50 mg tramadol in group II. While the consumption during the first 6 hours was comparable. From then on the consumption in group I increased significantly. Side effects were reported by 30 % in both the groups. Conclusion: Continuous infusion is better than bolus in term of easy administration and better pain control throughout postoperative care.

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