Tramadol-metoclopramide or remifentanil for patient-controlled analgesia during second trimester abortion: a double-blinded, randomized controlled trial

Study Objective: To compare patient-controlled analgesia (PCA) with tramadol with PCA with remifentanil in second trimester abortion. Design: Prospective, randomized double-blinded study Setting: University-affiliated medical center. Patients: 30 ASA physical status 1 and 2 patients undergoing a second trimester abortion. Interventions: Patients received PCA with either tramadol or remifentanil. Analgesia was initiated in the tramadol group by an initial loading dose of tramadol 1.0 mg/kg with 10 mg of metoclopramide followed by a PCA bolus of 0.3 mg/kg/mL of tramadol every 5 minutes. For remifentanil, which does not require a loading dose, a placebo of 100 mL of 0.9% normal saline was given followed by PCA of 0.4 mu g/kg/mL every two minutes. Measurements: Women were evaluated for pain via verbal analog score (VAS; 0-100), sedation, nausea, blood pressure, pulse, and respiratory rate. On the day of discharge, women were analyzed for overall satisfaction. Primary outcome was pain scores and general satisfaction. Main Results: Analysis by time yielded no statistically significant difference in VAS scores between the groups at any point except 16-20 hours after induction of labor, when pain was lower in the tramadol group (11.3 +/- 18.1 vs. 36.7 +/- 27.4; P = 0.04). The average VAS score was low in both groups, with no significant differences noted between groups (P = 0.74). Satisfaction scores were high in both groups, with no significant differences noted between them (P = 0.89). Conclusion: Both drugs are acceptable choices for pain control in patients undergoing second trimester abortions. (C) 2012 Elsevier Inc. All rights reserved.