SPANZA Advisory on Tramadol

Recommendations Following FDA Warnings about Tramadol Use in Children
  1. Tramadol can have a useful role as part of a multimodal analgesic regimen for managing acute pain in children.
  2. Tramadol dose should be limited for acute pain after tonsillectomy (e.g., maximum dose 1 mg/kg 6-8 h, max 400 mg/day). We suggest starting with a lower dose of 2 mg/kg daily in divided doses (e.g., 0.5 mg/kg 6-8 h). Tramadol overdose is a greater danger than CYP variants.
  3. Children with obstructive sleep apnoea who have undergone tonsillectomy should continue to be monitored in hospital overnight to assess both response and sensitivity to opioids before discharge. While evidence is lacking, it may be prudent to observe any child given opioids during a period of sleep before discharge.
  4. The use of any opioid in children after day-stay surgery should be done so with caution.

The full document can be downloaded here.

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