Abstract

Background: Tramadol hydrochloride is a centrally acting analgesic widely used in pediatric pain management. Its efficacy and safety in children with hereditary hematological conditions managed at specialist centers in Iraq remain inadequately documented. Objectives: This study aimed to evaluate the analgesic efficacy, dose–response relationship, and adverse-reaction profile of tramadol in pediatric patients at the Basra Centre for Hereditary Blood Diseases, as well as to identify clinical variables associated with the degree of analgesic response. Methods: A prospective observational study was conducted from September 2024 to January 2026. Thirty-eight pediatric patients aged 4–15 years who received tramadol were enrolled. Pain was quantified using the Numerical Rating Scale (NRS, 0–10) before and after administration. Response was classified as satisfactory (NRS reduction ≥2 points) or slow (<2 points). Group comparisons were performed using the Mann–Whitney U test and chi-square test. Results: Satisfactory analgesia was achieved in 29 patients (76.3%). The overall mean pain reduction was 3.03 ± 2.59 NRS units: 4.17 ± 1.34 in the satisfactory-response group versus −0.67 ± 2.18 in the slow-response group (p < 0.001). Intravenous (IV) infusion was associated with a significantly higher rate of satisfactory response than intramuscular (IM) injection (92.3% vs. 41.7%; χ² = 9.02, p = 0.003). Age (p = 0.808), sex (p = 0.460), and total dose (p = 0.397) were not significantly associated with analgesic outcome. Dizziness was the most frequent adverse event (n = 9, 23.7%); no serious adverse events occurred. Conclusion: IV tramadol infusion at approximately 1 mg/kg over 4 hours achieved satisfactory analgesia in the majority of pediatric patients with hereditary blood disorders. The route of administration was the principal determinant of analgesic response. Incorporating IV tramadol infusion into standardized pediatric pain protocols at hematological centers is recommended.