Tramadol, a new analgesic morphine for pediatric
Support evaluative and therapeutic pain of the child, can now appear both manageable and appropriate analgesics and expand marketing authorization of older products hitherto reserved for adults. Doctor use Prescription Tramadol for pediatric.
Bearing, 2 in Pediatrics
Tier 2 was poorly represented and used in pediatrics because of a lack of suitable presentations until recently.
Instead of level 2 in analgesic therapy is not well defined and limited post-operative intravenous Relay and too few prescriptions medicine. The bearing 2 is underused for reasons unclear (insufficient knowledge, user preference for the combination of drugs bearing an alternate). NSAIDs have taken a prominent place in therapy pain relief and some care must be given the side effects they cause, especially in prolonged use. Those who need they can Purchase Tramadol according to their doctor prescription.
Codeine is the only analgesic with a two-tier pediatric license at the age of 1 year orally. The best indication concerning the consolidated post-surgery (ambulatory surgery Relay intravenous). The indications for pediatric trauma and medical are still poorly known whether in a hospital environment as a Liberal.
Nalbuphine is widely used (AMM 18 months use from birth for very large teams), if the child has an intravenous (emergency, perioperative, intensive care, pediatric unit).
Dextropropoxyphene and nefopam are not licensed for 15 years, however there is a fairly common use of dextropropoxyphene in older children, judged by some more potent than codeine and causing fewer side effects.
Tramadol
This product has been marketed in 3 forms reserved for immediate-release oral and injectable form to patients over 15 years (1997), for the sustained release form to the child over 12 years (1999 ).
This product does not currently have pediatric presentation in US; while it is used in other European countries in small children (age> 1 year). An application for marketing authorization for oral solution is currently underway for children from 3 years and an extension of marketing authorization for the injectable form.
PHARMACOLOGY
Tramadol hydrochloride is an original molecule by its agonist action on opioid receptors and inhibit the reuptake of serotonin and norepinephrine related to the presence of two distinct isomers in pharmacological activity. Cheap Tramadol Online is available here for buy Tramadol.
These properties explain the efficacy of tramadol in pain as nociceptive in neuropathic pain.
Pharmacokinetics
Close to that of adults, the half-life is 5 to 6 hours and elimination is the urine as metabolites for 80% and 20% unchanged tramadol.
The oral analgesic effect appears within 30 minutes and lasts for about 4 hours.
Side Effects
Nausea and vomiting can be prevented by the administration of metoclopramide or phenothiazine, by no cons effectiveness of ondansetron (see lower analgesic potency of tramadol when used simultaneously: De Witte)
For all studies, the percentage of nausea and vomiting varies from 3 to 30%.
The other most common side effects are, like all opioids: respiratory depression, sedation, constipation.
Dosage
1 to 2 mg / kg 3-4 times per 24 hours without exceeding 8 mg/kg/24 hours for this injectable forms such as oral with the exception of oral delayed-release form.
REVIEW OF THE LITERATURE
The studies all relate to the combined analgesic efficacy and safety of producing more than 1500 children. Most were made in post-operative single dose or repeated for injectable and intravenous Relay or absence of intravenous to oral form.
The literature review presented here concerns only the children and the only intraoperative or postoperative period.
Intravenous
All studies in postoperative conclude the effectiveness of tramadol comparable perioperative and / or greater than those of analgesics tier 2 and some NSAIDs, and higher in all studies to paracetamol and placebo. Tolerance was satisfactory with better security than the Tier 3 and analgesic buprenorphine.
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