Original contributionA comparison of postoperative cognitive function and pain relief with fentanyl or tramadol patient-controlled analgesia☆
Introduction
Intravenous patient–controlled infusion of opioids (patient-controlled analgesia [PCA]) is a popular and effective analgesic technique. Little data are available on the effect of different opioids on cognitive function of patients while on PCA. Morphine was reported to preserve cognitive function better than hydromorphone in one study, [1] and fentanyl was reported to be superior to morphine in a second study. [2] Based on these limited data, it seems fentanyl might be the opioid of choice for PCA as far as preservation of cognitive function is concerned.
Tramadol is a centrally acting analgesic showing promise in a few areas including less sedation, less respiratory depression, and less euphoria, compared with other opioids [3], [4], [5], [6]. Although it is less sedating, it is not known whether the cognitive function of patients receiving tramadol for postoperative PCA may also be better preserved compared with other opioids.
The aim of the study was to compare the effect on cognitive function and the analgesic efficacy of PCA tramadol vs PCA fentanyl, the preferred “conventional” opioid.
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Materials and methods
The study was commenced after approval from the University of Hong Kong Faculty of Medicine ethics committee. This was a prospective, randomized, double-blind study. Only adult Cantonese-speaking Chinese patients scheduled for elective colorectal operations and who accepted PCA for postoperative analgesia were recruited. All patients were ASA physical status I, II, or III. Written, informed consent was obtained. Patients with known allergy to any component of perioperative anesthetic
Results
Thirty-one patients satisfied the criteria of inclusion and were randomized into two groups. One patient was excluded early because his preoperative BVRT test result was found missing, and therefore, only 30 patients were analyzed. Seventeen patients were randomized to group F and 13 to group T. The demographic data are summarized in Table 1.
For patients who could complete all the tests postoperatively, no significant differences in MMSE or BVRT scores were detectable between the two groups at
Discussion
Our study found that significantly more patients receiving tramadol PCA than fentanyl PCA were able to complete cognitively demanding tasks on the first postoperative day; however, we could not demonstrate superior cognitive function test scores in those receiving tramadol PCA.
Postoperative cognitive impairment is common, particularly in elderly patients [12]. Many factors contribute to its development [13]. Postoperative cognitive impairment is also associated with postoperative delirium [14],
Acknowledgments
This study was supported by a CRCG Research Grant from the University of Hong Kong (Acc Code 10202116/26981/20100/323/01). The authors thank Dr SL Tsui and members of the Division of Pain Medicine, Department of Anaesthesiology, Queen Mary Hospital, for their advice and support in this study. The authors also thank Ms Jeff Man for assistance with conduct of MMSE and BVRT and with statistical analysis.
References (23)
- et al.
Abuse potential and pharmacological comparison of tramadol and morphine
Drug Alcohol Depend
(1991) - et al.
Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction
Lancet
(1998) - et al.
The association of intraoperative factors with the development of postoperative delirium
Am J Med
(1998) - et al.
A multidimensional comparison of morphine and hydromorphone patient-controlled analgesia
Anesth Analg
(1996) - et al.
Postoperative cognitive impairment in the elderly. Choice of patient-controlled analgesia opioid
Anaesthesia
(1996) - et al.
Tramadol. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in acute and chronic pain states
Drugs
(1993) - et al.
The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients
Anesth Analg
(2000) - et al.
Efficacy and safety of tramadol versus morphine for moderate and severe postoperative pain with special regard to respiratory depression
Anesth Analg
(1992) - et al.
Circadian temperature and melatonin rhythms, sleep, and neurobehavioral function in humans living on a 20-h day
Am J Physiol
(1999) - et al.
Reliability and validity of the Cantonese version of Mini-Mental State Examination: a preliminary study
J HK Coll Psychiatry
(1994)
Cross-sectional versus longitudinal estimates of cognitive change in nondemented older people: a CERAD study. Consortium to Establish a Registry for Alzheimer's Disease
J Am Geriatr Soc
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Mitochondrial impairments contribute to spatial learning and memory dysfunction induced by chronic tramadol administration in rat: Protective effect of physical exercise
2017, Progress in Neuro-Psychopharmacology and Biological PsychiatryCitation Excerpt :Enhancement of cognitive function 30 min after oral administration of tramadol (50 mg/70 kg) has been reported in the elderly with chronic osteoarthritis (Freye and Levy, 2006). However, Ng et al. (2006) did not find any significant effects of patient-controlled administration of tramadol (20 mg) on short-term visual memory after lower abdominal surgery (Ng et al., 2006). Conversely, Zakaryaee et al. (2012) found impairments of memory and other cognitive functions following chronic administration of tramadol (Zakaryaee et al., 2012).
Coadministration of tramadol with aripiprazole and venlafaxine - The effect on spatial memory functions in male rats
2016, Pharmacological ReportsCitation Excerpt :Memory problems are associated with aging, but can also be of iatrogenic origin, especially when changes in memory occur suddenly, without prior symptoms of dementia [12]. Literature data confirm the positive effect of TRM on memory functions in humans [12–19]. Also, a 2nd generation antipsychotic–aripiprazole (ARI) [20–23] and an antidepressant–venlafaxine (VEN) [24], often used in patients with cognitive impairement, have proven to be effective in improving memory in the animal model.
Patient-controlled analgesia
2009, Annales Francaises d'Anesthesie et de ReanimationOpioid analgesics and narcotic antagonists
2009, Side Effects of Drugs AnnualCitation Excerpt :They recognized that delirium and/or cognitive impairment are common adverse events that affect morbidity and postoperative recovery and the limitations of the papers reviewed (e.g. small sample sizes and non-standardized measurement of cognitive impairment), and they recommended future studies of postoperative cognitive impairment in patients given postoperative opioids. In another study postoperative cognitive function was assessed after patient-controlled analgesia in 30 patients undergoing lower abdominal surgery, who received either fentanyl (n = 17) or tramadol (n = 13) intraoperatively and postoperatively (6c). Cognitive function was assessed on days 1 and 2 using the Mini Mental State Examination and the Benton Visual Retention Test.
Endogenous opiates and behavior: 2006
2007, Peptides
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This study was supported by a CRCG Research Grant from the University of Hong Kong (Acc Code 10202116/26981/20100/323/01), Hong Kong, China.
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Current address: Department of Anaesthesiology, Grantham Hospital, Hong Kong, China.