Patient controlled epidural analgesia after major urologic surgery: A comparison of tramadol with morphine

The purpose of the paper was to assess and to compare the effectiveness and safety of patient controlled epidural analgesia using tramadol or morphine for postoperative analgesia after major urological surgeries.For patient-controlled epidural analgesia; in group I (n = 30) a loading dose of 20 mg tramadol 0.1% with a continuous infusion of 1 mg/ml at a rate of 8 ml/h was administered preemptly and in group II (n = 30) a loading dose of 2 mg morphine in 20 ml normal saline was administered and a supplemental infusion of 0.2 mg/h morphine was begun at a rate of 2 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 minutes and a background infusion of 8 ml/h in tramadol 0.1% group and 2 ml/h in morphine 0.01% group were administered. VAS for pain intensity, vital signs, sedation scale and side effects were monitored at 0, 15, 30 minutes and 1, 2, 3, 4, 8, 12, 24 hours during the postoperative period.Adequate analgesia was provided in all patients. VAS values were significantly lower in group II than in group I after the fourth hour measurement (p < 0.05). The incidence of nausea, vomiting and pruritius was lower in the tramadol group (p < 0.05).In conclusion we decided that, after major urologic surgery, patient-controlled epidural administration of tramadol with a continuous background infusion might provide a safe and effective analgesia with limited side effects, even though there is increased drug consumption.