Tramadol use in pediatric sickle cell disease patients with vaso-occlusive crisis

Abstract

AIM: To evaluate whether the addition of scheduled oral tramadol to intravenous morphine and intravenous ketorolac reduces morphine requirements.

METHODS: This single-centered, Institutional Review Board-approved, retrospective study at Moses Cone Memorial Hospital included pediatric patients who were ≥ 2 years old with vaso-occlusive crisis (VOC) caused by sickle cell disease (SCD), were on morphine patient-controlled analgesia (PCA), and had scheduled oral tramadol added to their standard pain regimen. The study population was admitted between March 2008 and March 2011. The data was collected from electronic records and included age, weight, morphine use, tramadol use, hemoglobin, pain scores, number of days on PCA, length of hospital stay, respiratory rate, and polyethylene glycol use. Thirty patients were analyzed as independent admissions and seven patients as paired admissions.

RESULTS: Eighteen pediatric SCD patients with VOC received morphine PCA and intravenous ketorolac and twelve patients received morphine PCA and intravenous ketorolac and scheduled oral tramadol. Baseline characteristics were similar between both groups with the exception of the average weight, which was greater in the tramadol group than in the morphine group. The average morphine requirements in patients with and without the use of tramadol were similar, both for the independent admissions [0.58 mg/kg per day vs 0.65 mg/kg per day (P = 0.31)] and the paired admissions [0.71 mg/kg per day vs 0.77 mg/kg per day (P = 0.5)]. The daily polyethylene glycol requirement was less in the tramadol group for both the independent [0.5 g/kg per day vs 0.6 g/kg per day (P = 0.64)] and paired admissions analyses [and 0.41 g/kg per day vs 0.55 g/kg per day (P = 0.67)].

CONCLUSION: The addition of scheduled tramadol in patients receiving concomitant morphine and ketorolac demonstrates a trend toward decreased morphine and polyethylene glycol use.

Keywords: Pediatrics, Sickle cell, Tramadol, Morphine, Vaso-occlusive crisis

Core tip: A small clinical study has shown that balanced analgesia using intravenous morphine, intravenous ketorolac, and intravenous tramadol followed by erythrocytapheresis was effective, as shown by pain relief and significant improvement in mood and sleep, in seven sickle cell disease patients aged three to twenty-eight years who presented with vaso-occlusive crisis. The objective of this study is to evaluate whether the addition of scheduled oral tramadol to intravenous morphine plus intravenous ketorolac provides adequate pain relief, and reduces morphine requirements, adverse effects, length of patient-controlled analgesia therapy, and length of hospital stay.