Comparison of nerve conduction blocks by an opioid and a local anesthetic

Efficacy of peritonsillar infiltration with dexmedetomidine versus tramadol in comparison to placebo for pain control and sedation after tonsillectomy in pediatric patients: A randomized clinical trial

Objective

This article aimed to assess the efficacy of peritonsillar infiltration with dexmedetomidine-ropivacaine versus tramadol-ropivacaine for pain control and sedation after tonsillectomy in pediatric patients.

Materials and Methods

This double-blind clinical trial recruited 99 eligible children (4-8 years old) undergoing tonsillectomy and assigned to three block-randomized groups, receiving dexmedetomidine-ropivacaine (group A), tramadol-ropivacaine (group B), or placebo-ropivacaine (group C). The vital signs included blood pressure, heart rate, and SaO2 before anesthesia induction, during surgery at regular intervals until 24 h after surgery. The duration of surgery and recovery, complications, and analgesic consumption were recorded and pain scores were measured by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Oucher scales as well as sedation scores by the Wilson sedation scale. Data were analyzed within SPSS 20 at a significance level of 0.05.

Results

The lowest pain scores were measured by the CHEOPS scale in the dexmedetomidine-ropivacaine group (P < 0.05). Statistically significant difference was observed in the CHEOPS pain score between the first two groups at 30 min, 1 h, 2 h, and 4 h after surgery (P < 0.01). The differences were revealed in the Oucher pain assessments among all groups from the time of recovery to four postoperative hours (P < 0.05), with the lowest in the dexmedetomidine-ropivacaine group whose sedation score was greater during recovery and 5 min after surgery (P < 0.05). Subjects in tramadol group had six cases of dizziness and nausea, while no side effects were observed in two other groups (P < 0.05). Only seven participants receiving dexmedetomidine required acetaminophen, but 29 in the tramadol group and all in the placebo group demanded to receive acetaminophen (P = 0.001).

Conclusion

The authors concluded that dexmedetomidine as an adjuvant to ropivacaine has better performance in local infiltration for intra- and post-tonsillectomy analgesia and postoperative sedation, without any special side effects (like the placebo group), and that it hence is recommended to be used for local infiltration during tonsillectomy.

Clinical and Antinociceptive Effects of Distal Inferior Alveolar Nerve Block in Ponies With Tramadol 5% or Lidocaine 2

This study aimed to compare the antinociceptive effects of tramadol 5% and lidocaine 2% on mental nerve block in horses of the Brazilian Pony breed. Eight adult non-pregnant mares were used in this study. The ponies were tranquilized with acepromazine (5 µg kg^-1, IV), and the infiltration of the mental foramen was performed in Treatment 1- tramadol 5% (T, 150 mg) or Treatment 2- lidocaine 2% (L, 60 mg), both at a total dose of 3 ml in each foramen. Heart rate (HR), respiratory rate (RR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), rectal temperature (RT), and formation of skin lesions (SL) were evaluated. Evaluation of nociception of the outer lip (OL), inner lip (IL), and gingiva (GG) were performed using an electronic von Frey device with the evaluation of the ponies' reactions to each stimulus. From these reactions, we determined latency time (LT) and duration of antinociception (DAN). Analysis of variance with 16 observations was performed for HR, RR, SAP, DAP, MAP, LT and DAN. Data were expressed as mean ± standard deviation and the means were compared by the SNK and Student's t-test (P< 0.05). Changes in HR, RR, SAP, DAP, and MAP between evaluation times were associated with the effects of acepromazine (P>0.05). No formation of skin lesions was observed. Latency time did not differ between treatments (P>0.05). Both lidocaine 2% and tramadol 5% produced an antinociceptive effect. We conclude that the duration of the antinociceptive effect of tramadol 5% is longer than that of lidocaine 2%.

The efficacy and safety of peri-tonsillar administrated agents on pain treatment after pediatric tonsillectomy: A network meta-analysis

OBJECTIVES

We assessed the pain control efficacies and associated morbidities of drugs administered locally (around the tonsils) in pediatric patients undergoing a tonsillectomy.

METHODS

Randomized controlled trials up to April 2022 were retrieved from six databases. The treatment networks featured six interventions (ropivacaine, bupivacaine, levobupivacaine, ketamine, tramadol, and dexamethasone) and a control (placebo). The outcomes were the postoperative pain scores, the time to use of the first analgesic drugs, and postoperative nausea/vomiting. Both pairwise and network meta-analyses were performed.

RESULTS

All treatments controlled pain at 1 h and 1 day postoperatively. Although all agents tended to delay the time to the first analgesic drug, only bupivacaine, dexamethasone, ketamine, and tramadol significantly reduced the need for analgesics. No agent caused significant postoperative nausea or vomiting. The ranking hierarchy revealed that tramadol was superior in terms of pain control 1 h postoperatively, the time to the first analgesic drug, and the number of analgesic doses required; however, it ranked third in terms of operative time.

CONCLUSION

All drugs reduced postoperative pain. Tramadol was optimal in pain control, and dexamethasone also afforded good pain control with low incidences of nausea and vomiting.

Comparative study of Local Anesthetic Efficacy of 5% Tramadol Versus 2%Lignocaine with 1:100,000 adrenaline for Extraction of fully erupted Maxillary 3rd molars using Infiltration Anesthesia

Introduction

The majority of dental procedures need local anesthesia for pain control, and lidocaine/ lignocaine is the most commonly used anesthetic agent in dentistry. Although effective and safest, the anesthetic agent still has some complications. To overcome these many alternatives have been used. Tramadol has been shown to have some local anesthetic (LA) effects when used for infiltration anesthesia in dentistry.

Methods

In the present study, the local anesthetic efficacy of tramadol was compared with 2% lignocaine containing 1: 100,000 adrenaline for the extraction of maxillary fully erupted 3rd molar teeth. The parameters recorded included the onset of action, duration of action, intraoperative pain, post-operative analgesic effect, and incidence of an allergic reaction. A total of 200 patients were randomly divided into two groups. In group A -Each patient received 0.6 ml of 5% tramadol (Tramataj- 50 mg prepared by Taj pharma company) 0.4 ml buccally and 0.2 ml palatally for extraction of maxillary 3rd molar as local infiltration following strict aseptic precaution. In Group B- patients received 0.6 ml of 2% lignocaine containing 1: 100,000 adrenaline buccally and 0.2 ml palatally as infiltrations.

Results

It was found that 5% tramadol has a local anesthetic efficacy similar to 2% lignocaine with adrenaline but was found to be a comparatively weaker agent.

Conclusion

tramadol is a valid alternative for performing extractions in normal patients or patients allergic to lidocaine.

Effectiveness of tramadol compared to lignocaine as local anesthesia in the extraction of firm teeth: a randomized controlled trial

Background

The aim of this study was to compare the local anesthetic effect of tramadol with that of lignocaine in the extraction of immobile (grade 0) maxillary first molars.

Methods

This was a randomized, double-blind, equally balanced, controlled trial conducted on a sample population of 116 patients. The patients were randomly divided into two groups: group A (control) and group B (study). Group A and group B participants received 1.8 ml of 2% lignocaine without adrenaline and 1.8 ml of 5% tramadol, respectively through the supra-periosteal infiltration technique before extraction. Intraoperative pain was recorded on the Visual Analog Scale (VAS) and was evaluated using two unpaired t-tests.

Results

Intraoperative pain was evaluated in both the control and study groups. In the control group, the mean VAS score was 0.71 ± 0.81, while in the study group, the mean intraoperative VAS score was 1.21 ± 0.86, with the difference between the two mean values being statistically significant (P = 0.001).

Conclusion

Tramadol has a less potent local anesthetic effect than lignocaine. As a higher dose of tramadol is required to obtain the desired anesthetic effect, it should be used as a supplement to lignocaine in extensive surgical procedures. It can also be used in patients allergic to lignocaine.

Local infiltration of tramadol as an effective strategy to reduce post-operative pain: a systematic review protocol and meta-analysis

OBJECTIVE

The purpose of this review is to evaluate the use and effectiveness of the local administration of tramadol in reducing post-operative pain during surgical interventions.

METHODS

The PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases will be searched for this review. This systematic review will include studies evaluating the clinical efficacy of the local infiltration of tramadol, with no study design restrictions. Only studies that present clear descriptions of local tramadol administration are published in peer-reviewed journals in the English, Italian, Spanish, French, Portuguese or German language and are published in full will be taken into consideration. A meta-analysis will be performed when there is sufficient clinical homogeneity among the retrieved studies, and only randomized controlled studies and quasi-randomized controlled studies will be included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to assess the certainty in the evidence. If a quantitative analysis cannot be conducted, a qualitative description of the results of the retrieved studies will be provided.

RESULTS

A high-quality synthesis of the current evidence on the local administration of tramadol for managing post-surgical pain will be illustrated using subjective reports and objective measures of performance. The primary outcomes will include the magnitude of post-operative pain intensity improvement, with improvement being as defined by a reduction by at least 2 points in the visual analogue scale (VAS) score or numerical rating scale (NRS) score. The secondary outcomes will be the magnitude of reduction in tramadol rescue doses and in other analgesic drug doses.

CONCLUSION

This protocol will present evidence on the efficacy of tramadol in relieving post-surgical pain.

SYSTEMIC REVIEW REGISTRATION

PROSPERO CRD42018087381.

Inhibition of Fast Nerve Conduction Produced by Analgesics and Analgesic Adjuvants-Possible Involvement in Pain Alleviation

Nociceptive information is transmitted from the periphery to the cerebral cortex mainly by action potential (AP) conduction in nerve fibers and chemical transmission at synapses. Although this nociceptive transmission is largely inhibited at synapses by analgesics and their adjuvants, it is possible that the antinociceptive drugs inhibit nerve AP conduction, contributing to their antinociceptive effects. Many of the drugs are reported to inhibit the nerve conduction of AP and voltage-gated Na⁺ and K⁺ channels involved in its production. Compound action potential (CAP) is a useful measure to know whether drugs act on nerve AP conduction. Clinically-used analgesics and analgesic adjuvants (opioids, non-steroidal anti-inflammatory drugs, ₂-adrenoceptor agonists, antiepileptics, antidepressants and local anesthetics) were found to inhibit fast-conducting CAPs recorded from the frog sciatic nerve by using the air-gap method. Similar actions were produced by antinociceptive plant-derived chemicals. Their inhibitory actions depended on the concentrations and chemical structures of the drugs. This review article will mention the inhibitory actions of the antinociceptive compounds on CAPs in frog and mammalian peripheral (particularly, sciatic) nerves and on voltage-gated Na⁺ and K⁺ channels involved in AP production. Nerve AP conduction inhibition produced by analgesics and analgesic adjuvants is suggested to contribute to at least a part of their antinociceptive effects.

Effect of Premedication on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Systematic Review of the Literature

Background

Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth.

Methods

A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary.

Results

Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis.

Conclusion

Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.

Comparison of Local Anaesthetic Efficacy of Tramadol Versus Lignocaine for Extraction of Tooth Under Supraperiosteal Infiltration

Background

Tramadol has been shown to have a local anaesthetic effect when used as infiltration anaesthesia.

Methods

The local anaesthetic efficacy of tramadol was compared with that of lignocaine for the extraction of teeth in terms of their onset of action, duration of action, intraoperative pain, post-operative analgesic effect and adverse reactions. Apart from this, incidence of allergic reaction was also recorded for both the drugs. A total of 100 patients were divided into two groups randomly. Each patient was assigned to receive either a maximum of 2 ml of 5% tramadol (Supridol 50 mg, Neon laboratories), Group T (n = 50), as a local anaesthetic solution for extraction of maxillary premolar for orthodontic reason under supraperiosteal infiltration following strict aseptic precaution or a maximum of 2 ml of 2% lignocaine (Lox 2%, Neon laboratories), Group L (n = 50), in a double-blinded fashion.

Results

In group T, the mean subjective onset of action was 33.66 s, while in group L it was 33.06 s (p = 0.881). In group T, the mean objective onset of action was 3.04 min, while in group L it was 3.18 min (p > 0.05). The mean duration of action in group T was 55.60 min, while in group L it was 57.50 min (p = 0.432). Only 2 patients in group T and 1 patient in group L had nausea (p = 0.245).

Conclusion

We conclude that 5% tramadol has a local anaesthetic efficacy similar to 2% lignocaine but is comparatively a weaker agent.

New Findings on Local Tramadol Use in Oral Surgery

In modern times, all procedures in oral surgery need to be painless and management of postoperative pain needs to be adequate. The surgical extraction of the third molar or alveolectomy of the wisdom tooth is one of the most common surgical procedures carried out in oral surgery and it includes rising a flap, bone removal and suturing. These surgical procedures usually cause swelling, trismus and moderate to severe pain. Third molar surgery is often used as a model in clinical trials that are directed toward reducing postoperative pain and improving its management. Tramadol is a well-known central acting opioid analgesic that produces analgesia against multiple pain conditions such as postsurgical pain, obstetric pain, terminal cancer pain, pain of coronary origin and neuropathic pain. Tramadol is an atypical opioid. When administered locally, it has both analgesic and anesthetic properties. The aim of this paper was to present new findings on local effects of tramadol in oral surgery.

sec-Butylpropylacetamide (SPD), a new amide derivative of valproic acid for the treatment of neuropathic and inflammatory pain

Chronic pain is a multifactorial disease comprised of both inflammatory and neuropathic components that affect ∼20% of the world's population. sec-Butylpropylacetamide (SPD) is a novel amide analogue of valproic acid (VPA) previously shown to possess a broad spectrum of anticonvulsant activity. In this study, we defined the pharmacokinetic parameters of SPD in rat and mouse, and then evaluated its antinociceptive potential in neuropathic and acute inflammatory pain models. In the sciatic nerve ligation (SNL) model of neuropathic pain, SPD was equipotent to gabapentin and more potent than its parent compound VPA. SPD also showed either higher or equal potency to VPA in the formalin, carrageenan, and writhing tests of inflammatory pain. SPD showed no effects on compound action potential properties in a sciatic nerve preparation, suggesting that its mechanism of action is distinct from local anesthetics and membrane stabilizing drugs. SPD's activity in both neuropathic and inflammatory pain warrants its development as a potential broad-spectrum anti-nociceptive drug.

Local analgesic effect of tramadol is mediated by opioid receptors in late postoperative pain after plantar incision in rats

Tramadol is a drug used to treat moderate to severe pain. It is known to present a peripheral effect, but the local mechanisms underlying its actions remain unclear. The role of peripheral opioid receptors in postoperative pain is not well understood. In the present study, we examined the peripheral opioid receptors to determine the local effect of tramadol in a plantar incision pain model. Rats were subjected to plantar incision and divided into four groups on postoperative day (POD) 1: SF_SF, 0.9% NaCl injected into the right hindpaw; SF_TraI, 0.9% NaCl and tramadol injected into the right hindpaw; SF_TraC, 0.9% NaCl and tramadol injected into the contralateral hindpaw; and Nal_Tra, naloxone and tramadol injected into the ipsilateral hindpaw. To determine the animals' nociceptive threshold, mechanical hyperalgesia was measured before incision, on POD1 before treatment and at 15, 30, 45, and 60 minutes after the incision. The same procedure was repeated on the POD2. The expression levels of μ-opioid receptor (MOR) and δ-opioid receptor (DOR) were obtained through immunoblotting assays in the lumbar dorsal root ganglia (L3-L6) in naïve rats and 1, 2, 3, and 7 days after the incision. Our results showed that the plantar incision was able to cause an increase in mechanical hyperalgesia and that tramadol reversed this hyperalgesia on POD1 and POD2. Tramadol injections in the contralateral paw did not affect the animals' nociceptive threshold. Naloxone was able to antagonize the tramadol effect partially on POD1 and completely on POD2. The DOR expression increased on POD2, POD3, and POD7, whereas the MOR expression did not change. Together, our results show that tramadol promoted a local analgesic effect in the postoperative pain model that was antagonized by naloxone in POD2, alongside the increase of DOR expression.

Effects of different doses of tramadol added to levobupivacaine in continuous wound infusion for postoperative pain treatment following cesarean section

OBJECTIVE

The aim of this study was to compare the effects of two different doses of tramadol added to levobupivacaine as continuous wound infusion, on VAS scores following cesarean section.

METHODS

The study was conducted in an University Hospital and was approved by the Local Ethical Committee. Sixty-five ASA I-II parturients, between 18 and 45 years were enrolled. The participants were randomized to three groups. Group T1 (n = 21) was given the study solution consisting of levobupivacaine 0.25% + tramadol 1 mg/kg. Group T2 (n = 21) was given levobupivacaine 0.25% + tramadol 2 mg/kg and Group L (n = 21) was given levobupivacaine 0.25%, subcutaneously, alone. Each patient who delivered by cesarean section was applied a triple orifice epidural catheter above rectus fascia for continious wound infiltration. VAS at rest and with 20 degrees leg lift, time to first additional analgesic, total additional analgesic consumption, side effects, and sedation scores were recorded.

RESULTS

There were no statistically significant differences among groups, concerning VAS scores at rest and VAS scores at leg lift. Total amount of additional analgesics and sedation scores were also similar for three groups.

CONCLUSION

Different doses of tramadol as adjunct to local anesthetics in continuous wound infiltration following cesarean section do not seem to provide superior analgesia.

Anesthetic efficacy of meperidine in teeth with symptomatic irreversible pulpitis

Achieving adequate pulpal anesthesia in mandibular teeth is always a challenge. Supplementary injections and using drugs in combination are some methods implemented to overcome this hurdle. In this randomized clinical trial, use of meperidine in conjunction with lidocaine in intraligamentary injection did not exhibit significant improvement in anesthesia.

Local analgesic effect of tramadol is not mediated by opioid receptors in early postoperative pain in rats

BACKGROUND AND OBJECTIVES

Tramadol is known as a central acting analgesic drug, used for the treatment of moderate to severe pain. Local analgesic effect has been demonstrated, in part due to local anesthetic-like effect, but other mechanisms remain unclear. The role of peripheral opioid receptors in the local analgesic effect is not known. In this study, we examined role of peripheral opioid receptors in the local analgesic effect of tramadol in the plantar incision model.

METHODS

Young male Wistar rats were divided into seven groups: control, intraplantar tramadol, intravenous tramadol, intravenous naloxone-intraplantar tramadol, intraplantar naloxone-intraplantar tramadol, intravenous naloxone-intravenous tramadol, and intravenous naloxone. After receiving the assigned drugs (tramadol 5mg, naloxone 200 μg or 0.9% NaCl), rats were submitted to plantar incision, and withdrawal thresholds after mechanical stimuli with von Frey filaments were assessed at baseline, 10, 15, 30, 45 and 60 min after incision.

RESULTS

Plantar incision led to marked mechanical hyperalgesia during the whole period of observation in the control group, no mechanical hyperalgesia were observed in intraplantar tramadol group, intraplantar naloxone-intraplantar tramadol group and intravenous naloxone-intraplantar tramadol. In the intravenous tramadol group a late increase in withdrawal thresholds (after 45 min) was observed, the intravenous naloxone-intravenous tramadol group and intravenous naloxone remained hyperalgesic during the whole period.

CONCLUSIONS

Tramadol presented an early local analgesic effect decreasing mechanical hyperalgesia induced by plantar incision. This analgesic effect was not mediated by peripheral opioid receptors.

[Local analgesic effect of tramadol is not mediated by opioid receptors in early postoperative pain in rats]

BACKGROUND AND OBJECTIVES

Tramadol is known as a central acting analgesic drug, used for the treatment of moderate to severe pain. Local analgesic effect has been demonstrated, in part due to local anesthetic-like effect, but other mechanisms remain unclear. The role of peripheral opioid receptors in the local analgesic effect is not known. In this study, we examined role of peripheral opioid receptors in the local analgesic effect of tramadol in the plantar incision model.

METHODS

Young male Wistar rats were divided into seven groups: control, intraplantar tramadol, intravenous tramadol, intravenous naloxone-intraplantar tramadol, intraplantar naloxone-intraplantar tramadol, intravenous naloxone-intravenous tramadol, and intravenous naloxone. After receiving the assigned drugs (tramadol 5mg, naloxone 200μg or 0.9% NaCl), rats were submitted to plantar incision, and withdrawal thresholds after mechanical stimuli with von Frey filaments were assessed at baseline, 10, 15, 30, 45 and 60min after incision.

RESULTS

Plantar incision led to marked mechanical hyperalgesia during the whole period of observation in the control group, no mechanical hyperalgesia were observed in intraplantar tramadol group, intraplantar naloxone-intraplantar tramadol group and intravenous naloxone-intraplantar tramadol. In the intravenous tramadol group a late increase in withdrawal thresholds (after 45min) was observed, the intravenous naloxone-intravenous tramadol group and intravenous naloxone remained hyperalgesic during the whole period.

CONCLUSIONS

Tramadol presented an early local analgesic effect decreasing mechanical hyperalgesia induced by plantar incision. This analgesic effect was not mediated by peripheral opioid receptors.

Clinical pharmacy intervention post tonsillectomy: a randomized control trial

BACKGROUND

Pain control in pediatric patients undergoing tonsillectomy remains a dilemma. Tramadol and ketamine are reported to be an effective analgesic.

AIM OF THE STUDY

To evaluate the effect of peritonsillar infiltration of tramadol in combination with ketamine versus peritonsillar infiltration of tramadol posttonsillectomy.

SETTING

Specialty hospital in Jordan.

METHOD

Sixty children, aged 7-12 years, selected for tonsillectomy were enrolled in the study. We divided the patients into two groups 30 of each, Group I: received peritonsillar saline and peritonsillar infiltration of tramadol 2 mg/kg, Group II: received peritonsillar infiltration of ketamine 1.0 mg/kg added to peritonsillar tramadol 2 mg/kg.

MAIN OUTCOME MEASURE

Hemodynamic stability, pain scale, first request of analgesia, total analgesics consumption and post-operative nausea and vomiting (PONV) side effects were recorded 24 h after surgery.

RESULTS

The analysis of data showed that Group II had significantly lower face pain scale, longer time for first request of analgesia, and better hemodynamic stability than GI (p < 0.001). On the other hand the total analgesics requirements, time of surgery, and PONV showed no significant differences between the two groups.

CONCLUSION

Combined use of peritonsillar infiltration of ketamine 1.0 mg/kg with tramadol 2 mg/kg provided prolong analgesic effects, less pain with no side effect, and better hemodynamic stability compared with using tramadol alone in patients undergoing tonsillectomy.

Efficacy of tramadol as a preincisional infiltration anesthetic in children undergoing inguinal hernia repair: a prospective randomized study

Background

Preincisional local anesthetic infiltration at the surgical site is a therapeutic option for postoperative pain relief for pediatric inguinal hernia. Additionally, tramadol has been used as an analgesic for postoperative pain in children. Recently, the local anesthetic effects of tramadol have been reported. The aim of this study was to determine both the systemic analgesic and the local anesthetic effects of tramadol and to determine how it differs from bupivacaine when administered preincisionally.

Methods

Fifty-two healthy children, aged 2–7 years, who were scheduled for elective herniorrhaphy were randomly allocated to receive either preincisional infiltration at the surgical site with 2 mg/kg tramadol (Group T, n=26) or 0.25 mL/kg 0.5% bupivacaine (Group B, n=26). At the time of anesthetic administration, perioperative hemodynamic parameters were recorded. The pain assessments were performed 10 minutes after the end of anesthesia and during the first 6-hour period, using pain scores. The time of first dose of analgesia and need for additional analgesia were recorded.

Results

Between T and B groups, the anesthesia time, perioperative hemodynamic changes, and pain scores were not statistically different. However, in group B, the postoperative analgesic requirement was higher than in group T.

Conclusion

Tramadol shows equal analgesic effect to bupivacaine and decreases additional analgesic requirement, when used for preincisional infiltration anesthesia in children undergoing inguinal herniorrhaphy.

Effects of opioids on local anesthesia in the rat: a codeine and tramadol study

Opioids are central analgesics that act on the CNS (central nervous system) and PNS (peripheral nervous system). We investigated the effects of codeine (COD) and tramadol (TRAM) on local anesthesia of the sciatic nerve. Eighty Wistar male rats received the following SC injections in the popliteal fossa: local anesthetic with epinephrine (LA); local anesthetic without vasoconstrictor (LA WV); COD; TRAM; LA + COD; LA + TRAM; COD 20 minutes prior to LA (COD 20' + LA) or TRAM 20 minutes prior to LA (TRAM 20' + LA). As a nociceptive function, the blockade was considered the absence of a paw withdraw reflex. As a motor function, it was the absence of claudication. As a proprioceptive function, it was the absence of hopping and tactile responses. All data were compared using repeated-measures analysis of variance (ANOVA). Opioids showed a significant increase in the level of anesthesia, and the blockade duration of LA + COD was greater than that of the remaining groups (p < 0.05). The associated use of opioids improved anesthesia efficacy. This could lead to a new perspective in controlling dental pain.

Comparison of local anesthetic efficacy of tramadol hydrochloride (with adrenaline) versus plain tramadol hydrochloride in the extraction of upper molar teeth

PURPOSE

To evaluate the efficacy of local anesthesia using tramadol hydrochloride (HCl) with versus without adrenaline in the extraction of upper molar teeth.

PATIENTS AND METHODS

This was a double-blinded study that included 100 patients who required extraction of 1 upper molar by the conventional method and were allocated randomly into 1 of 2 groups: in group A (n = 50), each patient received an initial dose of drug A (tramadol HCl 50 mg and adrenalin 0.0225 mg diluted to 1.8 mL by distilled water); in group B (n = 50), each patient received an initial dose of drug B (tramadol HCl 50 mg diluted to 1.8 mL by distilled water). Degree of pain during tooth extraction, duration of surgery, and total number of cartridges used were recorded intraoperatively. Postoperatively, patients were instructed to record any adverse effects, such as nausea or vomiting, on the first day of the operation.

RESULTS

There were significant differences in the number of cartridges used and the degree of intraoperative pain. However, there was no significant difference in duration of surgery or side effects.

CONCLUSIONS

The results of this study suggest that tramadol HCl in combination with adrenaline can be used as an alternative local anesthetic in oral and maxillofacial surgery when, for some unusual reason, a patient cannot receive a conventional local anesthetic.

Preemptive subcutaneous tramadol for post-operative pain in lower abdomen surgeries: A randomized double blinded placebo-control study

Background:

Recently, the preemptive analgesic effects of subcutaneous infiltration of tramadol (T) in the site of incision have not been extensively studied. In this study, we investigated the effect of subcutaneous T infiltration before the incision of surgery on post-operative pain, in lower abdomen surgeries.

Materials and Methods:

This double-blind study was carried out on 90 patients (18-65 years) of American Society Anesthesiologists physical status I and II who were candidates for a lower abdomen surgery during 2011. They were randomly assigned to receive preemptive subcutaneous T or normal saline (NS). The visual analogue scale for pain (VAS) in rest and cough position and opium total dose consumption were compared between two groups in times 0, 15, 30, 60 min and 2, 4, 6, 12, 24 h after the surgery.

Results:

The VAS in cough and rest position in the first 24 h following the surgery was lower in group T (P < 0.05). Opium consumption was lower in group T (P < 0.05).

Conclusion:

Subcutaneous preemptive infiltration of T before surgical incision reduces post-operative opioid consumption.

Comparison of peritonsillar infiltration of tramadol and lidocaine for the relief of post-tonsillectomy pain

BACKGROUND

Several studies have reported the use of peritonsillar infiltrations of local anaesthetics and/or locally active analgesic drugs for the relief of post-tonsillectomy pain, with variable results in terms of quality and duration of analgesia. We aimed to compare the effects of peritonsillar infiltration of lidocaine versus tramadol versus placebo on post-tonsillectomy pain.

METHODS

Sixty patients over the age of 10 years undergoing bilateral elective tonsillectomy under general anaesthesia were randomised into three groups. The first group received peritonsillar infiltration of tramadol, the second 2 per cent lidocaine and the third normal saline. In all groups, peritonsillar infiltration was carried out after tonsillectomy but prior to tracheal extubation. Post-operative comparisons were made to assess the quality of pain control and the patients' analgesic requirements.

RESULTS

Peritonsillar infiltration of tramadol provided an analgesic effect comparable to that of lidocaine in the first 6 hours post-operation, as reflected by visual analogue scale pain scores and opioid requirements, which were lower compared with the placebo group.

CONCLUSION

Peritonsillar infiltration of tramadol provided pain control in the first 6 hours post-tonsillectomy which was comparable to that of lidocaine.

The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia

Background:

Bupivacaine, tramadol, and pethidine has local anesthetic effect. The aim of this study was to compare effect of subcutaneous (SC) infiltration of tramadol, pethidine, and bupivacaine on postoperative pain relief after cesarean delivery.

Materials and Methods:

120 patient, scheduled for elective cesarean section under spinal anesthesia, were randomly allocated to 1 of the 4 groups according to the drugs used for postoperative analgesia: Group P (Pethidine) 50 mg ,Group T (Tramadol) 40 mg, Group B (Bupivacaine 0.25%) 0.7 mg/kg, and Group C (control) 20CC normal saline injection in incision site of surgery. Pain intensity (VAS = visual analogous scale) at rest and on coughing and opioid consumption were assessed on arrival in the recovery room, and then 15, 30, 60 minutes and 2, 6, 12, 24 hours after that.

Results:

VAS scores were significantly lower in groups T and P compared with groups B and C except for 24 hours (VAS rest) and 6 hours (VAS on coughing) postoperatively (P < 0.05). The number of patients requiring morphine were significantly different between the groups (105 doses vs. 87, 56, 46, doses for group C, B, T and P, respectively, P < 0.05) in all the times, except for 2 and 6 hours postoperatively.

Conclusions:

The administration of subcutaneous pethidine or tramadol after cesarean section improves analgesia and has a significant morphine-sparing effect compared with bupivacaine and control groups.

The maternal and neonatal effects of adding tramadol to 2% lidocaine in epidural anesthesia for cesarean section

Background:

Opioid analgesics are commonly added to epidural local anesthetics to improve analgesia during surgery.

Objectives:

The goal of this study was to evaluate the maternal and neonatal effects of adding different doses of tramadol to 2% lidocaine in the epidural anesthesia for cesarean section.

Patients and Methods:

Ninety pregnant patients who were candidates for cesarean section under epidural anesthesia were randomly categorized into three groups. Group L received 2% lidocaine. In the LT50 and LT100 groups, 50 and 100 mg of tramadol were added to epidural 2% lidocaine. For additional analgesia during surgery, 2% lidocaine through epidural catheter or IV sufentanil were administered. Analgesia after surgery was provided by IV injection of meperidine. Onset and duration of sensory and motor blockades, total drug consumption, neonatal Apgar score, and complications were recorded.

Results:

In the LT100 group, onset of complete sensory and motor blockade at T6 was less than in the two other groups, but the highest level of sensory blockade and two segment regression and duration of motor blockades between the LT50 and LT100 groups were not significantly different, although they were higher and more prolonged than in the L group. Average lidocaine and sufentanil consumption during surgery between the LT50 and LT100 groups were not significantly different but were lower than in the L group. The incidence of maternal complications and neonatal Apgar scores were not significantly different between the three groups. In the LT50 and LT100 groups, the time until the first request for analgesics after surgery was prolonged, and average meperidine consumption was less than in the L group.

Conclusions:

The addition of tramadol to epidural 2% lidocaine offers advantages in cesarean section.

Analgesic efficacy of topical tramadol in the control of postoperative pain in children after tonsillectomy

PURPOSE

Pain control after tonsillectomy is still a controversial issue. Topical approaches have the advantage of pain control with good patient acceptability. Therefore, this study was conducted to evaluate the effects of topical tramadol on postoperative pain and morbidity in children undergoing tonsillectomy.

METHODS

A prospective, randomized, double-blind, controlled clinical study was designed. Forty children aged between 4 and 15 years, ASA I-II, scheduled for elective tonsillectomy and/or adenoidectomy were randomized into two groups. For patients in Group T (n = 20) swabs soaked with 2 mg/kg tramadol diluted in 10 ml saline were applied to both of their tonsillar fossa for 5 min; in the control group (n = 20) swabs soaked with 10 ml saline were applied. Postoperative pain scores, bleeding, nausea, vomiting, abdominal discomfort, constipation, pain in the throat, painful swallowing, fever, otalgia, trismus, and halitosis were recorded at the first, fifth, thirteenth, seventeenth, twenty-first, and twenty-fourth postoperative hours and the week after tonsillectomy.

RESULTS

Pain scores were found to be significantly lower at the 21st hour and on postoperative day seven in the tramadol group compared with the control group (p < 0.05). Mean daily pain scores ranged from Day 1: 0.34 (±0.21) to Day 7: 0.11 (±0.08) in the tramadol group and Day 1: 0.53 (±0.14) to Day 7: 0.42 (±0.15) in the control group. There were no significant differences in morbidity between the groups (p > 0.05).

CONCLUSION

Topical 5% tramadol with its local anesthetic effect seems to be an easy, safe, and comfortable approach for pain management in children undergoing tonsillectomy.

Effect of pulsed magnetic field on regenerating rat sciatic nerve: An in-vitro electrophysiologic study

Some experimental studies report that low-frequency pulsed electromagnetic field (PEMF) stimulation may accelerate regeneration in peripheral nerves. In the present study, effects of PEMF on the regeneration of the crushed rat sciatic nerves were investigated with histological and in-vitro electrophysiological methods (sucrose-gap). After crush injury of the sciatic nerves, rats were divided into 5, 15, 25, 38 day-groups and exposed to PEMF (1.5 h/day, intensity; 1.5 mT, consecutive frequency; 10-40-100 Hz). In the 15th day post crush, compound action potential (CAP) amplitude was measured as 5.5+/-1 mV (crush group) and 5.4+/-1.2 mV (crush+PEMF group). In addition, half width of CAP extended ~3 fold in both groups and frequency-dependent amplitude inhibition (FDI) decreased approximately 20% at 100 Hz. In the 38th day, amplitude of CAP, half width of CAP and FDI were measured nearly intact nerve values in both groups. In histological examinations, Wallerian degeneration was observed similar progress between both groups. The results were compared between crush and crush + PEMF groups, it was found that the effect of PEMF was not significant. The authors conclude that PEMF were ineffective on rat sciatic nerve regeneration.

Effect of tramadol on the rat sciatic nerve conduction: a numerical analysis and conduction velocity distribution study

The aim of this study was to document the effect of tramadol as an opioid on individual fibers of rat sciatic nerve. To accomplish this objective, compound action potentials (CAPs) were recorded from isolated nerves treated with tramadol from five different concentration levels. Then recorded CAPs and the control group were analyzed by numerical methods namely Conduction Velocity Distribution (CVD) and Fast Fourier Transform (FFT). The results show that the area under CAP and the time derivative of CAP curves decreases, and the excitability of the nerve trunk falls as well (rheobase and chronaxie increases) with increasing tramadol concentration. CVD deduced by model study was divided into subgroups as SLOW (8-26 m/s), MODERATE (26-44 m/s), MEDIUM (44-60 m/s) and FAST (60-78 m/s). The decrement in percentage relative contribution of these conduction velocity groups starts with a concentration of 0.25 mM tramadol, especially in the subgroup named FAST. The power spectrum shifts from higher frequency region to lower frequency region as the tramadol concentration increases. These findings show that fast conducting fibers are more susceptible to tramadol than medium and moderate groups and tramadol possibly acts on channel activity rather than passive properties (such as space and time constant) of nerve fibers.

Subcutaneous Tramadol Infiltration at the Wound Site Versus Intravenous Administration after Pyelolithotomy

Background:

Recently, the peripheral anesthetic effect of tramadol has been the theme of many studies. The postoperative analgesic effects of subcutaneous wound infiltration with tramadol have not been extensively studied and compared with those of intravenous administration.

Objective:

To compare the therapeutic effects and complications of intravenous versus local wound infiltration of using tramadol following pyelolithotomy.

Methods:

This double-blind study was carried out on 60 patients (age 18–60 y) of American Society of Anesthesiologists physical status I–II who were awaiting pyelolithotomy in Sina Hospital, Tehran, Iran, during 2006 and 2007. They were randomly assigned to receive intravenous or subcutaneous wound infiltration with tramadol. Vital signs, the intensity of pain (visual analog scale), and the level of consciousness (Ramsey Sedation Scale [RSS]), as well as the frequency of nausea and vomiting were recorded during 30 minutes to 1 hour after the patient entered the recovery room. Vital signs were also recorded every hour until 6 hours postoperatively and then on the day after the patient was transferred to the ward.

Results:

The RSS was lower in patients who had received subcutaneous infiltration of tramadol (p < 0.001). A significant difference was noted in the severity of pain between the groups; it was higher in the group that received intravenous tramadol. The average time for the first meperidine requirement was 45.2 ±8.4 min (mean ± SD) in the subcutaneous group and 21.6 ± 12.4 min in the intravenous group. Total meperidine consumption was lower in patients who had received subcutaneous wound infiltration with tramadol compared with those who had received intravenous tramadol (p < 0.001). Nausea and vomiting were more frequent during the first hour of recovery; the complication, however, was less frequent in the subcutaneous group.

Conclusions:

Subcutaneous wound infiltration with tramadol reduces postoperative opioid consumption and produces less nausea and vomiting than does intravenous administration.

Inhibitory effects of opioids on compound action potentials in frog sciatic nerves and their chemical structures

An opioid tramadol more effectively inhibits compound action potentials (CAPs) than its metabolite mono-O-demethyl-tramadol (M1). To address further this issue, we examined the effects of opioids (morphine, codeine, ethylmorphine and dihydrocodeine) and cocaine on CAPs by applying the air-gap method to the frog sciatic nerve. All of the opioids at concentrations less than 10 mM reduced the peak amplitude of the CAP in a reversible and dose-dependent manner. The sequence of the CAP peak amplitude reductions was ethylmorphine>codeine>dihydrocodeine> or = morphine; the effective concentration for half-maximal inhibition (IC(50)) of ethylmorphine was 4.6 mM. All of the CAP inhibitions by opioids were resistant to a non-specific opioid-receptor antagonist naloxone. The CAP peak amplitude reductions produced by morphine, codeine and ethylmorphine were related to their chemical structures in such that this extent enhanced with an increase in the number of -CH(2) in a benzene ring, as seen in the inhibitory actions of tramadol and M1. Cocaine reduced CAP peak amplitudes with an IC(50) value of 0.80 mM. It is concluded that opioids reduce CAP peak amplitudes in a manner being independent of opioid-receptor activation and with an efficacy being much less than that of cocaine. It is suggested that the substituted groups of -OH bound to the benzene ring of morphine, codeine and ethylmorphine as well as of tramadol and M1, the structures of which are quite different from those of the opioids, may play an important role in producing nerve conduction block.

Post-herniorrhapy infiltration of tramadol versus bupivacaine for postoperative pain relief: a randomized study

BACKGROUND AND OBJECTIVES

Inguinal hernia repair is frequently associated with persistent postoperative discomfort and pain and late discharge from the hospital. We evaluated the postoperative analgesic effect of local wound infiltration with tramadol following herniorrhaphy among adult patients.

PATIENTS AND METHODS

Forty-three adult male patients were randomly assigned to two groups; group T (n=23) received tramadol 1 mg/kg in 10 mL 0.9% normal saline and group B (n=20) received 10 mL of 0.25% bupivacaine, both as a local wound infiltration prior to skin closure. Postoperatively, pain severity, time to first analgesic requirement, analgesic consumption, and incidence of side effects were recorded.

RESULTS

During the first postoperative day, there was a significant difference between the two groups in the recorded visual analog scale rating higher in group B (P<.05) and the time to first analgesic requirement (6.6A+/-0.99 hours in group B vs 3.7+/-0.74 hours in group T; P<.05). There was no difference in the incidence of side effects among the two groups. Postoperative consumption of fentanyl and diclofenac was higher in group B than group T (65% vs 18% and 80% vs 21.7%, respectively, P

CONCLUSIONS

Locally infiltrated tramadol prior to herniorrhaphy wound closure provides better pain relief compared to bupivacaine in adult patients.

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MESH Headings

• Adolescent
• Adult
• Analgesics, Opioid/administration & dosage
• Analgesics, Opioid/therapeutic use
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/administration & dosage
• Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
• Bupivacaine/administration & dosage
• Bupivacaine/therapeutic use
• Diclofenac/administration & dosage
• Diclofenac/therapeutic use
• Fentanyl/administration & dosage
• Fentanyl/therapeutic use
• Hernia, Inguinal/surgery
• Humans
• Incidence
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative/drug therapy
• Risk Factors
• Severity of Illness Index
• Time Factors
• Tramadol/administration & dosage
• Tramadol/therapeutic use
• Treatment Outcome

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Grants Collapse

Affiliation(s)

Abdullah M Kaki Department of Anaesthesia, Faculty of Medicine, King Abdalaziz University Hospital, Jeddah, Saudi Arabia
Waleed Al Marakbi

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Effects of intramuscular and peritonsillar injection of tramadol before tonsillectomy: a double blind, randomized, placebo-controlled clinical trial

BACKGROUND/AIMS

Our objective was to investigate the efficacy of intramuscular injection and peritonsillar infiltration of tramadol to prevent pain in children undergoing tonsillectomy.

METHODS

In a double-blinded trial, 45 children were randomized into three groups: infiltration anesthesia with tramadol (2 mgkg(-1)) to the peritonsillar area (INF group, n=15), intramuscular analgesia with tramadol (2 mgkg(-1)) (IM group, n=15), and the placebo controls (PL group, n=15). Visual analog scale (VAS) scores for pain assessment, heart rate (HR) and mean arterial pressure (MAP) during and after anesthesia were recorded.

RESULTS

Mean HR values were higher in INF than PL group at 10th, 20th, and 30th minutes of operation (P<0.05). Nine children required analgesics within the first hour after surgery in PL compared to 1 child in INF group (P=0.036). VAS scores on awakening were significantly better in INF than PL group (P=0.015). The difference between IM and PL groups was not significant for any of the parameters.

CONCLUSION

Peritonsillar infiltration with tramadol provided good intraoperative analgesia, less postoperative pain on awakening and lower analgesic requirement within the first hour after surgery.

Pre-emptive analgesic effect of tramadol after mandibular third molar extraction: a pilot study

PURPOSE

We compared the efficacy of tramadol given before or immediately after surgical extraction of an impacted mandibular third molar under local anesthesia.

MATERIALS AND METHODS

In this prospective, randomized, controlled, double-blind pilot study, 3 groups of 20 patients each were included: tramadol preoperative, 100 mg intramuscularly (IM) 1 hour before surgery (group A); tramadol postoperative, 100 mg IM immediately after surgery (group B); and saline (group C). We evaluated intensity of pain and analgesic consumption as was requested.

RESULTS

The analgesic efficacy measured as complete relief of pain at 24 hours was 86% in the preemptive tramadol compared with 70% and 36% for postoperative tramadol administration and control group. A significant reduction in the consumption of analgesics was seen in preoperative group as compared with the postoperative and control groups. Adverse events were minimal and similar in all groups.

CONCLUSIONS

This study suggests the preemptive use of tramadol as an alternative for the acute pain treatment after the removal of an impacted mandibular third molar carried out under local anesthesia.