Double-blind randomized study of tramadol vs. paracetamol in analgesia after day-case tonsillectomy in children.

Fifty children (2-9 years) scheduled for tonsillectomy were enrolled in a double-blind randomized prospective study to compare postoperative analgesia provided with propacetamol/paracetamol (acetaminophen) or tramadol. A standard anaesthetic technique was used; each patient received sufentanil 0.25 microg kg(-1) intravenously followed with either i.v. propacetamol 30 mg kg(-1) or tramadol 3 mg kg(-1) before surgical incision. For postoperative analgesia, each child received either tramadol drops (2.5 mg kg(-1)) or paracetamol (acetaminophen) suppositories (15 mg kg(-1)), 6 and 12 h after surgery the first day and three times a day during postoperative days 2 and 3. This dosage of paracetamol is lower than the current recommended dosage, which is 40 mg kg(-1) loading dose followed by 20 mg kg(-1) 8 h(-1). Rescue medication consisted of i.v. diclofenac (1 mg kg(-1)) during the first six postoperative hours and oral ibuprofen (6-9 mg kg(-1)) afterwards. Postoperative pain scores (Children's Hospital of Eastern Ontario Pain Scale) in recovery, numerical pain scale in the ward and at home, and rescue analgesic use were significantly lower in the tramadol group. No serious adverse effects were observed.

The effects of intraoperative intravenous clonidine on gastric intramucosal PCO2.

UNLABELLED: To investigate the effects of clonidine given as an anesthetic adjunct on splanchnic perfusion, we determined intramucosal gastric PCO2 using gastric tonometry in 60 patients scheduled for large intestine surgery. After induction of anesthesia, patients were randomly assigned to four groups. Patients in Group 1 received an IV infusion of sufentanil (0.2 microg x kg(-1) x h(-1)); patients in Group 2 received an IV infusion of clonidine (4 microg/kg in 20 min followed by 2 microg x kg(-1) x h(-1)); patients in Group 3 received an IV infusion of ketamine (0.5 mg/kg followed by 0.25 mg x kg(-1) x h(-1)); patients in Group 4 received an epidural infusion of bupivacaine (7 mL of 0.5% followed by 5 mL/h of 0.25%). Gastric intramucosal PCO2 was assessed immediately before skin incision and every hour during surgery using a nasogastric tube. A last measurement was taken after skin closure. An arterial sample was collected simultaneously to measure arterial PCO2. Oxygen consumption (VO2/min) was continuously recorded. Gastric intramucosal PCO2 significantly increased during surgery in all groups independent of the anesthetic technique considered (P < 0.01) and was not related to metabolic changes or blood pressure variations. This increase, however, remains in the physiologic range. In conclusion, our results demonstrate that clonidine given as an anesthetic adjutant at the dose used has no deleterious effect on splanchnic perfusion during colonic surgery. IMPLICATIONS: IV clonidine given as an anesthetic adjunct at a dose of 4 microg/kg in 20 min, followed by 2 microg x kg(-1) x h(-1), has no deleterious effect on splanchnic perfusion during colonic surgery.