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KMID : 0363120180310030206
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Korean Journal of Pain
2018 Volume.31 No. 3 p.206 ~ p.214
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The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial
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Sayed Jehan Ahmed
Elshafy Sayed Kaoud Abd
Kamel Emad Zareif
Riad Mohamed Amir Fathy
Mahmoud Amal Ahmed
Khalaf Ghada Shalaby
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Abstract
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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 24th hour, and at the 72nd 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.
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KEYWORD
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Abdomen, Caudal anesthesia, C-reactive protein, Cytokine, Differential leukocyte count, Immune response, Interleukin 6, Leukocytes, Surgery, Pediatrics, Tramadol, Post-operative pain
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