The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial원문보기
Sayed, Jehan Ahmed
(Department of Anesthesia, College of Medicine, Assiut University)
,
Elshafy, Sayed Kaoud Abd
(Department of Anesthesia, College of Medicine, Assiut University)
,
Kamel, Emad Zareif
(Department of Anesthesia, College of Medicine, Assiut University)
,
Riad, Mohamed Amir Fathy
(Department of Pediatric, College of Medicine, Assiut University)
,
Mahmoud, Amal Ahmed
(Department of Clinical Pathology, College of Medicine, Assiut University)
,
Khalaf, Ghada Shalaby
(Department of Critical Care and Emergency Nursing, Faculty of Nursing, Assiut University)
Background: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. Methods: Sixty ASA-I pediatric patients aged 3-10 years undergoing lower abdominal surgery....
Background: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. Methods: Sixty ASA-I pediatric patients aged 3-10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/ kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales. Results: Postoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the $24^{th}$ hour, and at the $72^{nd}$ hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B. Conclusions: Adding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.
Background: Immune responses appear to be affected by anesthetics and analgesics. We investigated the effects of caudal tramadol on the postoperative immune response and pain management in pediatric patients. Methods: Sixty ASA-I pediatric patients aged 3-10 years undergoing lower abdominal surgery. Patients were randomly assigned either to a caudal bupivacaine (0.25%) group (group B), or a group that received caudal tramadol (1 mg/kg) added to the bupivacaine (0.25%) (group T). Both were diluted in a 0.9% NaCl solution to a total volume of 1ml/ kg. The systemic immune response was measured by collecting blood samples preoperatively, at the end of anesthesia, and at 24 and 72 hours postoperatively, and studied for interleukin IL-6, C-reactive proteins (CRP) cortisol levels, and leucocytes with its differential count. Postoperative pain was assessed along with sedation scales. Results: Postoperative production of IL-6 was significantly higher in group B at the end of anesthesia, than at the $24^{th}$ hour, and at the $72^{nd}$ hour in group B and group T, respectively. The immune response showed leukocytosis with increased percentages of neutrophil and monocytes, and a decreased lymphocyte response rate within both groups with no significant differences between the groups. Cortisol and CRP were significantly higher in group B. Conclusions: Adding tramadol to a caudal bupivacaine block can attenuate the pro-inflammatory cytokine response, Cortisol, and CRP in children undergoing lower abdominal surgery.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
제안 방법
Heart rate (HR), mean arterial blood pressure (MBP), and peripheral oxygen saturation (SPO2) were recorded before the induction of anesthesia, every 5 m intra-operatively, every 30 minutes for 120 minutes after transfer to PACU, hourly for the first 12 hours, and every two hours for the next 12 hours.
05 mg/kg/dose. The patient was placed in the lateral decubitus position (on the right side) with the hips and knees flexedat a right angle. At the end of the surgery, a peripheralvenous blood sample was taken, and the neuromuscular block was antagonized by neostigmine (50 mcg/kg) with atropine (20 mcg/kg) before extubation.
The secondary outcomes included the pediatric observational FLACC (Face, Legs, Activity, Cry, Consolability scale) pain scale (Table 1), time to the first rescue analgesia, the sedation scale, hemodynamic variables, and any adverse effects during the first 24 hours after surgery.
대상 데이터
A total number of 60 patients were randomly enrolled in this study (Fig. 1). There were non-significant differences between groups regarding age, body weight, gender, and duration of anesthesia or type of surgery (Table 2).
All participants underwent elective lower abdominal surgeries in the Children’s Hospital of Assiut University.
An informed parent’s consent was obtained. Sixty children of American Society of Anesthesiologists (ASA) physical status I, aged 3-10 years were enrolled in this double-blind prospective, comparative clinical study. All participants underwent elective lower abdominal surgeries in the Children’s Hospital of Assiut University.
05 using a confidence interval of 95%. Thirty patients were enrolled in each group to compensate for any dropouts during the study. Statistical analysis was done using the computer program IBM, SPSS (Statistical Package for Social Sciences), Version 20.
데이터처리
Data were expressed as mean, median, range, standard deviation (SD), numbers, or percentages as appropriate to the type of this data. Categorical variables were analyzed using thechi-square (x2) test. Continuous parametric variables were analyzed using an unpaired Student’s t-test.
Continuous parametric variables were analyzed using an unpaired Student’s t-test.
Continuous parametric variables were analyzed using an unpaired Student’s t-test. Nominal and non-normally distributed variables were analyzed through a Mann-Whitney U test. A P values ＜ 0.
이론/모형
Interleukin-6 concentration was measured from a plasma sample which was centrifuged immediately after separation and stored at−70oC for not more than two months, and non-competitive ELISA technique (A vibionhuman-orgenum, Rev 4.10) was used.
Statistical analysis was done using the computer program IBM, SPSS (Statistical Package for Social Sciences), Version 20. Normality of data distribution was evaluated with the Kolmogorov-Smirnov test. Data were expressed as mean, median, range, standard deviation (SD), numbers, or percentages as appropriate to the type of this data.
1 Khan S Memon MI Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children with hypospadias repair J Coll Physicians Surg Pak 2008 18 601 604 18940114
2 Stefano GB Scharrer B Smith EM Hughes TK Jr Magazine HI Bilfinger TV Opioid and opiate immunoregulatory processes Crit Rev Immunol 1996 16 109 144 8879941
4 Carli F Mayo N Klubien K Schricker T Trudel J Belliveau P Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial Anesthesiology 2002 97 540 549 12218518
5 Hole A Unsgaard G Breivik H Monocyte functions are depressed during and after surgery under general anaesthesia but not under epidural anaesthesia Acta Anaesthesiol Scand 1982 26 301 307 7124304
6 Hashimoto T Hashimoto S Hori Y Nakagawa H Hosokawa T Epidural anaesthesia blocks changes in peripheral lymphocytes subpopulation during gastrectomy for stomach cancer Acta Anaesthesiol Scand 1995 39 294 298 7793203
7 Fan S Zhong JL Chen WX Chen WL Li QX Wang YY Postoperative immune response and surgical stress in selective neck dissection: Comparison between endoscopically assisted dissection and open techniques in cT1-2N0 oral squamous cell carcinoma J Craniomaxillofac Surg 2017 45 1112 1116 28679471
8 Shakhar G Ben-Eliyahu S Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol 2003 10 972 992 14527919
9 Raghavan S Harvey AD Humble SR New opioid side effects and implications for long-term therapy Trends Anaesth Crit Care 2011 1 18 21
10 Volk T Schenk M Voigt K Tohtz S Putzier M Kox WJ Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery Anesth Analg 2004 98 1086 1092 15041604
11 Lönnqvist PA Ivani G Moriarty T Use of caudal- epidural opioids in children: still state of the art or the beginning of the end Paediatr Anaesth 2002 12 747 749 12519132
12 Snyder GL Greenberg S Effect of anaesthetic technique and other perioperative factors on cancer recurrence Br J Anaesth 2010 105 106 115 20627881
13 Jensen KB Lonsdorf TB Schalling M Kosek E Ingvar M Increased sensitivity to thermal pain following a single opiate dose is influenced by the COMT val (158)met polymorphism PLoS One 2009 4 e6016 19547755
14 Niesters M Proto PL Aarts L Sarton EY Drewes AM Dahan A Tapentadol potentiates descending pain inhibition in chronic pain patients with diabetic polyneuropathy Br J Anaesth 2014 113 148 156 24713310
15 Merkel SI Voepel-Lewis T Shayevitz JR Malviya S The FLACC: a behavioral scale for scoring postoperative pain in young children Pediatr Nurs 1997 23 293 297 9220806
16 Liu YM Zhu SM Wang KR Feng ZY Chen QL Effect of tramadol on immune responses and nociceptive thresholds in a rat model of incisional pain J Zhejiang Univ Sci B 2008 9 895 902 18988309
17 Zhou LW Ding HL Li MQ Jin S Wang XS Ji LJ Effect of tramadol on perioperative immune function in patients undergoing gastric cancer surgeries Anesth Essays Res 2013 7 54 57 25885721
18 Sacerdote P Bianchi M Gaspani L Manfredi B Maucione A Terno G The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients Anesth Analg 2000 90 1411 1414 10825330
19 Liu Z Gao F Tian Y Effects of morphine, fentanyl and tramadol on human immune response J Huazhong Univ Sci Technolog Med Sci 2006 26 478 481 17120754
20 Watkins LR Maier SF Goehler LE Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states Pain 1995 63 289 302 8719529
21 Senel AC Akyol A Dohman D Solak M Caudal bupivacaine-tramadol combination for postoperative analgesia in pediatric herniorrhaphy Acta Anaesthesiol Scand 2001 45 786 789 11421842
22 Prakash S Tyagi R Gogia AR Singh R Prakash S Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy Br J Anaesth 2006 97 385 388 16798773
24 Wolf AR Hughes D Wade A Mather SJ Prys-Roberts C Postoperative analgesia after paediatric orchidopexy: evaluation of a bupivacaine-morphine mixture Br J Anaesth 1990 64 430 435 1970738
26 Kumar P Rudra A Pan AK Acharya A Caudal additives in pediatrics: a comparison among midazolam, ketamine, and neostigmine coadministered with bupivacaine Anesth Analg 2005 101 69 73 15976208
27 Girwalkar-Bagle A Thatte W Choudhari S Preemptive caudal anaesthesia in children with bupivacaine- tramadol and levobupivacaine-tramadol: a randomized, double-blind, prospective study Anaesth Pain Intensive Care 2015 19 13 19
28 Güneş Y Gündüz M Unlügenç H Ozalevli M Ozcengiz D Comparison of caudal vs intravenous tramadol administered either preoperatively or postoperatively for pain relief in boys Paediatr Anaesth 2004 14 324 328 15078378
29 Prosser DP Davis A Booker PD Murray A Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery Br J Anaesth 1997 79 293 296 9389843
30 Murthy BV Pandya KS Booker PD Murray A Lintz W Terlinden R Pharmacokinetics of tramadol in children after i.v. or caudal epidural administration Br J Anaesth 2000 84 346 349 10793594
31 Solanki NM Engineer SR Jansari DB Patel RJ Comparison of caudal tramadol versus caudal fentanyl with bupivacaine for prolongation of postoperative analgesia in pediatric patients Saudi J Anaesth 2016 10 154 160 27051365
※ AI-Helper는 부적절한 답변을 할 수 있습니다.