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PAIN MEDICINE

The Addition of a Tramadol Infusion to Morphine Patient-Controlled Analgesia After Abdominal Surgery: A Double-Blinded, Placebo-Controlled Randomized Trial

Ashley R. Webb, MB BS, FANZCA^*, Samuel Leong, MB BS, FANZCA^*, Paul S. Myles, MB BS, MPH, MD, FFARCSI, FANZCA, and Sara J. Burn, BA RN^*

*Department of Anaesthesia, Frankston Hospital, Frankston; and Department of Anaesthesia and Pain Management, Alfred Hospital, Prahran, Victoria, Australia

Address correspondence and reprint requests to Dr. Ashley R. Webb, Department of Anaesthesia, Frankston Hospital, Hastings Road, Frankston, Victoria, 3199 Australia. Address e-mail to awebb{at}phcn.vic.gov.au

In this double-blinded, randomized controlled trial, we tested whether the addition of tramadol to morphine for patient-controlled analgesia (PCA) resulted in improved analgesia efficacy and smaller morphine requirements compared with morphine PCA alone after abdominal surgery in adults. Sixty-nine patients were randomly allocated into two groups, each receiving morphine 1 mg/mL via PCA after surgery. The tramadol group received an intraoperative initial loading dose of tramadol (1 mg/kg) and a postoperative infusion of tramadol at 0.2 mg · kg^-1 · h^-1. The control group received an intraoperative equivalent volume of normal saline and a postoperative saline infusion. Postoperatively, tramadol was associated with improved subjective analgesic efficacy (P = 0.031) and there was significantly less PCA morphine use in the tramadol group (P = 0.023). No differences between the groups were found with regard to nausea, antiemetic use, sedation, or quality of recovery (all P > 0.05). We conclude that a tramadol infusion combined with PCA morphine improves analgesia and reduces morphine requirements after abdominal surgery compared with morphine PCA alone.

IMPLICATIONS: In this study, we determined whether adding a second pain-killing drug, tramadol, could improve pain relief after major surgery in patients receiving morphine patient-controlled analgesia. We found that patients receiving tramadol had significantly better opinions of their pain relief and used significantly less morphine with no increase in side effects.

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