Clinical Observation Of Tramadol In Patient-Controlled Analgesia Pump In 42 Postoperative Pediatric Patients

IntroductionThe effective relief of pain is of paramount importance to anyone treating patients undergoing surgery. This should be achieved for humanitarian reasons, but there is now evidence that pain relief has significant physiological benefit. Not only does effective pain relief mean a smoother postoperative course with earlier discharge from hospital, but it may also reduce the onset of chronic pain syndromes. Pain serves a biological function. It signals the presence of damage or disease within the body. The goal for postoperative pain management is to reduce or eliminate pain and discomfort with a minimum of side effects as cheaply as possible. Postoperative pain relief must reflect the needs of each patient. So comes the patient-controlled analgesia, which can avoid the plasma concentration of analgesic from fluctuation. Management of pain in children is often inadequate and there is no evidence to support the idea that pain is less intense in neonates and young children due to their developing nervous system. Children tend to receive less analgesia than adults and the drugs are often discontinued sooner. Furthermore, it is simply not true that potent analgesics are dangerous when used in children because of the risks of side effects and addiction. Inefficient postoperative pain relief of pediatric patients will affect the results of operation and even the patients' future behavior.Methods42 pediatric patients underwent surgery, using patient-controlled analgesia pumps, were enrolled in this study. These patients were awake before operation and their intellectual and lingual developments were normal, having no cardiac or pulmonary malfunction, ASAI~II. Age 10.3卤2.46 years old, and body weight 32.88卤10.6kg. The operations performed included 2 upper abdomial operations, 16 lower abdominal operations and 24 orthopedic operations. 41 general anesthesia and 1 spinal-epidural anesthesia were performed.When the operation was finished, and after the patient could open eyes on demand as well as spontaneous respiration went well, inject 1.3~2.0mg/kg tramadol intravenously as load dose. Before leaving the operation room, connect patient-controlled analgesia pump with 10-15.5mg/kg tramadol to the patient's venous cannula. Follow up for 48 hours after operation. The following up included: (1) postoperative pain intensity using visual analogue scale; (2) sedative stages; (3) blood pressure, heart rate, respiratory rate and SpO2 before operation, after operation, 24 hours after operation and 48 hours after operation; (4) side effects including nausea and vomit, respiratory depression, difficulty in micturition, itching, dizziness and lower limbs numbness; (5) the dosage and times of extra analgesic injection.Results(1) The VAS were 3.02 2.38 and 1.65 1.87 at 24 hours after operation and 48 hours after operation, respectively. (2) sedative grading: grade I33cases, grade II7cases, grade III lease, grade IV lease. (3) there were no significant differences of blood pressure, heart rate, respiratory rate and SpO2 among the following time points: before operation, after operation, 24 hours after operation and 48 hours after operation. (4) side effects: 8 patients had dizziness at 24hours after operation, 7 patients had dizziness at 48hours after operation, 2 patients had difficulty in micturition, 2 patients had lower limbs numbness and 3 patients had itching, but not severe. Gas exhaust time were 38.38 13.98 hours after operation. No patient has respiratory inhibition. (5) two patients whose weight were 20kg and 50kg got extra 20mg and 50mg tramadol intravenous injection for less satisfaction of analgesia.DiscussionPain causes an increase in the sympathetic response of the body with subsequent rises in heart rate, cardiac work and oxygen consumption. Prolonged pain can reduce physical activity and lead to venous stasis and an increased risk of deep vein thrombosis and consequent pulmonary embolism. In addition, there can be widespread effects on gut and urinary tract motility, which may lead, in...