We designed this prospective, randomized, double-blind study to compare the analgesic effectiveness and side effects of IV patient-controlled morphine, pethidine, and tramadol for postoperative pain management. One-hundred-twenty-six ASA physical status I or II patients undergoing abdominal hysterectomy were randomly allocated to receive IV-patient controlled morphine (M), pethidine (P), or tramadol (T) for postoperative analgesia. The cumulative analgesic consumption over 24 h was 25.7 +/- 9.5 mg for morphine, 266 +/- 90 mg for pethidine, and 320 +/- 10 mg for tramadol. The average supplementary fentanyl dose used was significantly higher in group T than in groups M and P (P < 0.05). In conclusion, morphine, pethidine, and tramadol resulted in equivalent pain scores and side effects, but tramadol group T required more rescue analgesic doses of fentanyl.

Objective: In this study, the authors investigated the effect of the addition of remifentanil to tramadol or morphine for patient-controlled analgesia (PCA). Design: Prospective, randomized, double-blind, controlled study. Setting: University Hospital. Patients, participants: The authors randomly allocated 133 patients undergoing major abdominal surgery to receive IV PCA with tramadol alone, tramadol plus remifentanil, morphine alone or morphine plus remifentanil. Interventions: Bolus doses of tramadol (0.2 mg/kg), tramadol (0.2 mg/kg) plus remifentanil (0.2 μg/kg), morphine (0.02 mg/kg), or morphine (0.02 mg/kg) plus remifentanil (0.2 μg/kg) were available every 10 minutes without time limit or background infusion. Main outcome measure(s): Discomfort, sedation, pain scores, side effects, and total and bolus tramadol and morphine consumption were recorded for up to 24 hours after the start of PCA. Results: Pain scores at rest and movement were greater with tramadol alone than in the other groups at 1, 2, and 6 hours (p < 0.0125). The addition of remifentanil reduced cumulative tramadol consumption at 6, 12, and 24 hours, but not morphine consumption. More patients required supplementary rescue analgesia with meperidine, and with greater dosage, with tramadol alone (p < 0.001), and the incidence of nausea was greater with tramadol alone. The addition of remifentanil not only significantly improved discomfort scores in remifentanil groups, but also increased the degree of sedation in morphine-remifentanil group. Conclusions: After major abdominal surgery, adding remifentanil to PCA tramadol resulted in better pain scores, lower analgesic consumption, and fewer side effects when compared with tramadol alone. However, analgesic outcome with remifentanil was not prominent in MR group as much as in TR group.

Background/Objective: Throat packs are widely used during orofacial surgery to reduce the frequency of postoperative nausea and vomiting (PONV). However, evidence supporting their use is mixed, with associated risks such as postoperative sore throat and the possibility of being forgotten in situ. Methods: The aim of this study is to evaluate the effectiveness of throat packs in preventing PONV and postoperative sore throat during dental treatments under general anesthesia in children with special healthcare needs (SHCNs). Eighty children with SHCNs were randomized into two groups: throat packing (Group TP, n = 41) and no throat packing (Group n-TP, n = 39). A throat pack was used in Group TP, and PONV and sore throat were evaluated at 1, 2, and 4 h postoperatively. Statistical Package for Social Sciences (SPSS) version 23.0 was used for data analysis. The registration number at ClinicalTrials.gov is NCT06169306, registered on 28 December 2023. Results: Patients in Group n-TP showed significantly higher PONV values at 1 and 2 h postoperatively (p < 0.001, p = 0.019, respectively). Visual Analog Scale (VAS) values were also significantly higher in Group TP at 1 and 2 h postoperatively (p < 0.001, p = 0.002, respectively). Conclusions: Using throat packs in dental treatments under general anesthesia for children with SHCNs reduced the incidence of PONV but increased the incidence of postoperative sore throat.