Does tramadol wound infiltration offer an advantage over bupivacaine for postoperative analgesia in children following herniotomy? YAVUZ DEMIRARAN MD MD *, ZEKERIYA ILCE MD MD †, BUKET KOCAMAN MD MD * AND PERVIN BOZKURT MD MD ‡ *Department of Anesthesiology, School of Medicine, Abant Izzet Baysal University, Konuralp/ Duzce, Turkey, †Department of Pediatric Surgery, School of Medicine, Abant Izzet Baysal University, Konuralp/Duzce, Turkey and ‡Department of Anesthesiology, School of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey Summary Background: It has been demonstrated that tramadol is an effective analgesic. We aimed to compare postoperative analgesic effects of wound infiltration with tramadol (T) or bupivacaine (B) and intra- muscular tramadol (I) after herniotomy in children. Methods: In this study, 75 children were randomly assigned to group T, group B and group I. Wound infiltration was performed to the patients in group T (2 mgÆkg )1 tramadol in 0.2 mlÆkg )1 saline) and group B (0.2 mlÆkg )1 0.25% bupivacaine) into the surgical incision. Twenty minutes before the end of the surgery 2 mgÆkg )1 tramadol was injected i.m. in group I. Faces pain scale was used for assessing pain severity. Patients with pain score >2 were treated with paracetamol. The frequency of side effects and analgesic use were recorded. Patients were discharged on the next day. Results: No side effects were recorded in any group. The pain scores of the patients at the first, fourth and eighth hours were significantly higher in group B and group I than group T (P < 0.05). The pain scores of the patients at the first hour were significantly higher in group I compared with group B (P < 0.05). Average time to first analgesic requirement was significantly longer in group T (6.72 ± 4.09 h after herniotomy than both group I (4.49 ± 3.9 h) and group B (6.04 ± 3.7 h) (P < 0.05). Conclusions: Wound infiltration with tramadol may be a good choice for postoperative analgesia in children having inguinal herniotomy. Keywords: wound infiltration; tramadol; postoperative analgesia; herniotomy Introduction Effective analgesia after herniotomy in children is essential and several techniques are used, such as administration of opioids, nonsteroidal inflamma- tory drugs, peripheral nerve block, caudal block and wound infiltration with local anesthetics (1–3). Local anesthetic effects of opioids have been demonstrated in both clinical and laboratory studies (4–6). Tramadol is a weak opioid and selective for the N receptors and has recently been reported to Correspondence to: Yavuz Demiraran, Osmaniye Mah, Prestij Konutlari, Kat: 3, Daire: 24, Akcakoca, Duzce 81100, Turkey (email: demiryvz@yahoo.com). Pediatric Anesthesia 2006 16: 1047–1050 doi:10.1111/j.1460-9592.2006.01910.x Ó 2006 The Authors Journal compilation Ó 2006 Blackwell Publishing Ltd 1047