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Materials and Methods: Following Ethics Committee approval and informed patient consent 90 ASA I or II patients undergoing abdominal hysterectomy were allocated randomly to receive IV-PC morphine (M), pethidine (P) or tramadol (T) for postoperative analgesia. Twenty minutes before the end of surgery, all patients received a standardised loading dose of morphine (0.1 mg kg−1), pethidine (1 mg kg−1) or tramadol (1 mg kg−1) for postoperative analgesia in a double-blind fashion. They were then allowed to use a patientcontrolled analgesia (PCA) device giving boluses of morphine (0.02mg kg−1), pethidine (0.2 mg kg−1) or tramadol (0.2 mg kg−1). Pain, sedation and nausea scores, cumulative analgesic consumption, the number of patient requiring rescue fentanyl, time to recovery, and any side effects were recorded after recovery and at 1, 2, 6, 12 and 24 hours after the start of PCA.
Results and Discussions: The total analgesic consumptions were 25.7 ± 9.5mg for morphine, 266 ± 90mg for pethidine and 341 ± 111 mg for tramadol in 24 hour. The ratio of morphine/pethidine/tramadol dose sizes, used for postoperative pain management, was a ratio 1/10/13, respectively. Twenty-four patients (26.6%); four in group M (13.3%), six in group P (20%) and fourteen in group T (46.6%), complained of pain during the first twentyfour hour despite the PCA therapy. The number of patients requiring rescue fentanyl and average supplementary fentanyl dose used were significantly higher in T group than in M and P groups (p < 0.05). However, there was no difference between group M and P.
Conclusion(s): In patients, who underwent abdominal hysterectomy, patient controlled morphine and pethidine has provided better pain control with similar side-effects than tramadol, perhaps making them better suited for IV-PCA. Thus, tramadol should be reserved for those patients, in whom morphine or pethidine is judged inappropriate because of high rescue fentanyl requirement.
