Combination of oral tramadol and midazolam vs midazolam alone as a premedication in children undergoing adenotonsillectomy

The aim of this study was to compare the combination of oral tramadol and midazolam to oral midazolam alone, in children undergoing adenotonsillectomy, as an oral premedication, regarding also sedation and postoperative pain relief. Sixty children selected for elective adenotonsillectomy were enrolled in this randomized, controlled prospective study. Patients were randomly allocated into two groups. Group M (n=30) received 0.5 mg.kg-1 oral midazolam and group MT (n=30) received 0.2 mg.kg-1 oral midazolam with 1 mg.kg-1 oral tramadol as a premedication 30min preoperatively. Standard general anesthesia technique was used. A 5 points-sedation score (1 asleep to 5 agitated) on arrival to the operating room, a 3 points-acceptance score of separation from the parents and a 3 points-mask cooperation score at induction of anesthesia (1 easy to 3 markedly resistant) were used. Aldrete score, extubation time and intraoperatively consumption of remifentanil were also recorded. Pain intensity was assessed using a modification of the Hannallah pain score scale at 30min, 6h and 24h postoperatively. If pain score was higher than 3, additional analgesics were provided. Cumulative analgesic consumption in 24hrs was also noted. A satisfactory level of sedation scores were recorded in both groups. Group MT offered significantly more children in an awake, calm and quiet state, who were easily separated from their parents. The parental separation scores did not differ statistically significant between groups. The mask acceptance was statistically significant easier in group MT, while children in midazolam group (group M) were statistically significant resistant compared to children in group MT. Pain and modified Aldrete scores were comparable between groups. The amount of remifentanil consumed intraoperatively was statistically significant lower in group MT. Postoperative analgesic consumption was lower in group MT compared to group M but with no statistical significance. Adding oral tramadol to midazolam as a premedication in children provides good quality of sedation and decreases perioperative analgesic requirements following adenotonsillectomy.