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Bustam A, Poh K, Zambri A, Mohd Nazri MZA, Subramaniam T, Abdullah AA, Nor Azman AIH, Ang BT, Noor Azhar AM. Subcutaneous versus intravenous tramadol for extremity injury with moderate pain in the emergency department: a randomised controlled noninferiority trial. Eur J Emerg Med 2023; 30:331-340. [PMID: 37276052 DOI: 10.1097/mej.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND IMPORTANCE Musculoskeletal trauma is a common presentation in the emergency department (ED). Tramadol as an analgesic has been recommended by pain management guidelines for musculoskeletal pain. Parenteral tramadol in the ED is commonly administered intravenously. Subcutaneously administered tramadol may have other advantages such as easier and faster preparation, avoids the need for intravenous (i.v.) access, and reduces the incidence of respiratory and gastrointestinal effects. However, studies comparing subcutaneous (s.c.) and i.v. tramadol for the management of acute moderate pain in patients with extremity injury are lacking. OBJECTIVE The objective of this study was to compare the clinical efficacy of s.c. tramadol vs. i.v. tramadol in patients with moderate pain due to extremity injury in the ED. DESIGN, SETTINGS, AND PARTICIPANTS This non-inferiority randomized controlled trial included adult patients presented to an academic, tertiary hospital ED with moderate pain (pain score of 4-6 on the visual analog scale) due to extremity injury. Intervention patients stratified to pain score were randomized to receive 50 mg of i.v. or s.c. tramadol. OUTCOMES MEASURE AND ANALYSIS Primary outcome measure was the difference in the pain score reduction at 30 min after tramadol administration between the two groups. The noninferiority null hypothesis was that the therapeutic difference in terms of pain score reduction of more than 0.8 exists between the two treatment groups at the endpoint. MAIN RESULTS In total 232 patients were randomized to i.v. ( n = 115) or s.c. ( n = 117). Although 225 were analyzed in the per-protocol population (i.v. = 113; s.c. = 112). The baseline median pain score was 6 (IQR, 5-6). Median pain score reduction at 30 min after administration was 2 (IQR, 1-3) in the IV group vs. 2 (IQR, 1-2) in the s.c. group with a median difference of 0 (IQR, 0-0), which was below the prespecified noninferiority margin of 0.8. Adverse events in the i.v. group were higher compared to the s.c. group (33.6% vs. 8.9%, P ≤ 0.001). CONCLUSIONS The s.c. tramadol is noninferior to i.v. tramadol in the treatment of moderate pain from extremity injuries.
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Affiliation(s)
- Aida Bustam
- Department of Emergency Medicine, University Malaya, Kuala Lumpur
| | - Khadijah Poh
- Department of Emergency Medicine, University Malaya, Kuala Lumpur
| | - Aliyah Zambri
- Department of Emergency Medicine, University Malaya, Kuala Lumpur
| | | | | | | | | | - Bin Ting Ang
- Department of Emergency Medicine, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
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Omara-Reda H, Ouachikh O, Hamdi D, Lashin M, Hafidi A. Reinforcing effect of tramadol in the rat. Neurosci Lett 2023; 796:137053. [PMID: 36621588 DOI: 10.1016/j.neulet.2023.137053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
Tramadol is one of the most commonly prescribed analgesic opioids in various pharmacopeias. Tramadol has been linked to abuse in recent clinical investigations. However, the behavioral effects and neural substrates of the drug have not been well characterized in preclinical studies. As a result, the present study investigated the effects of tramadol on behavioral sensitizations in rats. Its impacts on cellular and molecular alterations in the brain were also investigated. In conditioned place preference (CPP) paradigm, tramadol induced behavioral as well as motor sensitizations. These effects were dramatically reduced by intraperitoneal administration of naltrexone, an opioid receptor antagonist. Tramadol caused changes in several molecular markers (pERK1/2, Δ-FosB, PKCγ, PKMζ GAD67) in the anterior cingulate cortex, which could indicate an increase in excitation within this structure. Tramadol is demonstrated in the present study to be a reinforcing drug in rats, as it increased both behavioral and motor sensitizations. Tramadol's effects are most likely due to the high levels of excitation it causes in the brain, which is mostly caused by the activation of opioid receptors.
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Affiliation(s)
- Hend Omara-Reda
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, TGI, 63000 Clermont-Ferrand, France
| | - Omar Ouachikh
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, TGI, 63000 Clermont-Ferrand, France
| | - Dhouha Hamdi
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, TGI, 63000 Clermont-Ferrand, France
| | - Mohamed Lashin
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, TGI, 63000 Clermont-Ferrand, France
| | - Aziz Hafidi
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, TGI, 63000 Clermont-Ferrand, France.
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Antihyperalgesic and Antiallodynic Effects of Amarisolide A and Salvia amarissima Ortega in Experimental Fibromyalgia-Type Pain. Metabolites 2022; 13:metabo13010059. [PMID: 36676984 PMCID: PMC9863681 DOI: 10.3390/metabo13010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
Salvia amarissima Ortega is an endemic species of Mexico used in folk medicine to alleviate pain and as a nervous tranquilizer. The S. amarissima extract and one of its abundant metabolites, identified and isolated through chromatographic techniques, were investigated to obtain scientific evidence of its potential effects to relieve nociplastic pain such as fibromyalgia. Then, the extract and amarisolide A (3-300 mg/kg, i.p.) were pharmacologically evaluated in reserpine-induced fibromyalgia-type chronic pain and in depressive-like behavior (as a common comorbidity) by using the forced swimming test in rats. The 5-HT1A serotonin receptor (selective antagonist WAY100635, 1 mg/kg, i.p.) was explored after the prediction of a chemical interaction using in silico analysis to look for a possible mechanism of action of amarisolide A. Both the extract and amarisolide A produced significant and dose-dependent antihyperalgesic and antiallodynic effects in rats, as well as significant antidepressive behavior without sedative effects when the antinociceptive dosages were used. The 5-HT1A serotonin receptor participation was predicted by the in silico descriptors and was corroborated in the presence of WAY100635. In conclusion, S. amarissima possesses antihyperalgesic, antiallodynic, and anti-depressive activities, partially due to the presence of amarisolide A, which involves the 5-HT1A serotonin receptor. This pharmacological evidence suggests that S. amarissima and amarisolide A are both potential alternatives to relieve pain-like fibromyalgia.
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Ziafat K, Polderman S, Nabavi N, Preston R, Chau A, Krausz MR, Schwarz SKW, Maclure M. Opioid dispensing after Cesarean delivery in British Columbia: a historical cohort analysis from 2004 to 2019. Can J Anaesth 2022; 69:997-1006. [PMID: 35764863 PMCID: PMC9244301 DOI: 10.1007/s12630-022-02271-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/09/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To describe postdischarge opioid dispensing after Cesarean delivery (CD) in 49 hospitals in British Columbia (BC) and assess opportunities for opioid stewardship. Methods Using the BC Ministry of Health’s Hospital Discharge Abstract Database, we linked 135,725 CDs performed in 2004–2016 and 30,919 CDs performed in 2017–2019 (length of stay ≤ four days) by deidentified Personal Health Numbers to data on medications dispensed from all BC community pharmacies (PharmaNet). We excluded patients with cancer and those to whom opioids have been dispensed in the year before. We measured trends in annual percentages of patients dispensed opioids within seven days (opioid rate), with 95% confidence intervals (CIs), stratified by hospital and opioid type, adjusted for length of stay, and for autocorrelation within hospital using generalized linear modeling. Results The opioid dispensation rate dropped from 31% (95% CI, 30 to 33) in 2004 to 16% (95% CI, 15 to 17) in 2016, where it remained through 2019. Five hospitals showed steep reductions from over 40% to under 10% within two to three years, but in most hospitals the opioid dispensation rate decreased slowly—11 had little reduction and three showed increases. Codeine dispensing dropped from 31% in 2004–2008 by 4% per year, while tramadol and hydromorphone dispensing rose. After 2015, rates were stable (hydromorphone, 8%; tramadol, 6%; codeine, 3%; and oxycodone, 0.5%). Conclusion After Health Canada’s 2008 warning against codeine use by breastfeeding mothers, post-CD opioid dispensing declined disjointedly across BC hospitals. Rates did not decrease further after the opioid overdose epidemic was declared a public health emergency in BC in 2016. The present study highlights opportunities for quality improvement and opioid stewardship through monitoring using administrative databases. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-022-02271-8.
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Affiliation(s)
- Kimia Ziafat
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Stefanie Polderman
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Rm. 11224, Vancouver, BC, V5Z 1M9, Canada
| | - Noushin Nabavi
- Health Sector Information, Analysis and Reporting, British Columbia Ministry of Health, Victoria, BC, Canada
| | - Roanne Preston
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Rm. 11224, Vancouver, BC, V5Z 1M9, Canada
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Anthony Chau
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Rm. 11224, Vancouver, BC, V5Z 1M9, Canada
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Michael R Krausz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Rm. 11224, Vancouver, BC, V5Z 1M9, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, 2775 Laurel Street, Rm. 11224, Vancouver, BC, V5Z 1M9, Canada
- Health Sector Information, Analysis and Reporting, British Columbia Ministry of Health, Victoria, BC, Canada
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Tay HP, Wang X, Narayan SW, Penm J, Patanwala AE. Persistent postoperative opioid use after total hip or knee arthroplasty: A systematic review and meta-analysis. Am J Health Syst Pharm 2021; 79:147-164. [PMID: 34537828 PMCID: PMC8513405 DOI: 10.1093/ajhp/zxab367] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To identify the proportion of patients with continued opioid use after total hip or knee arthroplasty. Methods This systematic review and meta-analysis searched Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and International Pharmaceutical Abstracts for articles published from January 1, 2009, to May 26, 2021. The search terms (opioid, postoperative, hospital discharge, total hip or knee arthroplasty, and treatment duration) were based on 5 key concepts. We included studies of adults who underwent total hip or knee arthroplasty, with at least 3 months postoperative follow-up. Results There were 30 studies included. Of these, 17 reported on outcomes of total hip arthroplasty and 19 reported on outcomes of total knee arthroplasty, with some reporting on outcomes of both procedures. In patients having total hip arthroplasty, rates of postoperative opioid use at various time points were as follows: at 3 months, 20% (95% CI, 13%-26%); at 6 months, 17% (95% CI, 12%-21%); at 9 months, 19% (95% CI, 13%-24%); and at 12 months, 16% (95% CI, 15%-16%). In patients who underwent total knee arthroplasty, rates of postoperative opioid use were as follows: at 3 months, 26% (95% CI, 19%-33%); at 6 months, 20% (95% CI, 17%-24%); at 9 months, 23% (95% CI, 17%-28%); and at 12 months, 21% (95% CI, 12%-29%). Opioid naïve patients were less likely to have continued postoperative opioid use than those who were opioid tolerant preoperatively. Conclusion Over 1 in 5 patients continued opioid use for longer than 3 months after total hip or knee arthroplasty. Clinicians should be aware of this trajectory of opioid consumption after surgery.
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Affiliation(s)
- Hui Ping Tay
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Xinyi Wang
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Sujita W Narayan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Asad E Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.,Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Saiz-Rodríguez M, Valdez-Acosta S, Borobia AM, Burgueño M, Gálvez-Múgica MÁ, Acero J, Cabaleiro T, Muñoz-Guerra MF, Puerro M, Llanos L, Martínez-Pérez D, Ochoa D, Carcas AJ, Abad-Santos F. Influence of Genetic Polymorphisms on the Response to Tramadol, Ibuprofen, and the Combination in Patients With Moderate to Severe Pain After Dental Surgery. Clin Ther 2021; 43:e86-e102. [PMID: 33812699 DOI: 10.1016/j.clinthera.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/22/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to elucidate the influence on analgesic effect of genetic polymorphisms in enzymes responsible for biotransformation of tramadol and ibuprofen or other possible genes involved in their mechanism of action. METHODS The study population comprised 118 patients from a multicenter, randomized, double-blind, placebo-controlled, Phase III clinical trial that assessed the analgesic efficacy and tolerability of a single dose of ibuprofen (arginine)/tramadol 400/37.5 mg compared with ibuprofen arginine 400 mg alone, tramadol 50 mg alone, and placebo in patients with moderate to severe pain after dental surgery. We analyzed 32 polymorphisms in the cytochrome P450 (CYP) enzymes COMT, ABCB1, SLC22A1, OPRM1, and SLC22A1. FINDINGS We did not find any statistically significant difference among CYP2C9 phenotypes related to ibuprofen response, although CYP2C9 poor metabolizers had a longer effect (higher pain relief at 6 hours). Likewise, we did not find any statistically significant difference among PTGS2 genotypes, contradicting previously publications. IMPLICATIONS There was not a clear effect of CYP2D6 phenotype on tramadol response, although CYP2D6 poor metabolizers had a slower analgesic effect. Concerning the transport of CYP2D6, we observed a better response in individuals carrying ABCB1 mutated alleles, which might correlate with higher tramadol plasma levels. Finally, we found a statistically significant better response in patients carrying the OPRM1 A118G G allele, which contradicts the previous reports. Measuring the active metabolite O-desmethyl-tramadol formation would be of great importance to better evaluate this association because O-desmethyl-tramadol has a higher μ-opioid receptor affinity compared with the parent drug. EudraCT.ema.europa.eu identifier: 2013-004637-33.
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Affiliation(s)
- Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain; Research Unit, Fundación Burgos por la Investigación de la Salud, Hospital Universitario de Burgos, Burgos, Spgrain
| | - Sarahí Valdez-Acosta
- Ethics Committee for Research with medicinal products and Clinical Research Unit, Fundación de investigación Biomédica, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Miguel Burgueño
- Department of Oral and Maxillofacial Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - María Ángeles Gálvez-Múgica
- Clinical Pharmacology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Julio Acero
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Teresa Cabaleiro
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain
| | - Mario Fernando Muñoz-Guerra
- Department of Oral and Maxillofacial Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Department of Oral and Maxillofacial Surgery, University Hospital Montepríncipe, San Pablo CEU University, Madrid, Spain
| | - Miguel Puerro
- Clinical Pharmacology Department, Hospital Central de la Defensa Gomez Ulla, Departamento de Ciencias Biomédicas, Universidad de Alcalá, Madrid, Spain
| | - Lucia Llanos
- Clinical Research Unit, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Dolores Martínez-Pérez
- Department of Oral and Maxillofacial Surgery, Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain; UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Antonio J Carcas
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Facultad de Medicina, Universidad Autónoma de Madrid, Instituto de Investigación Sanitaria La Princesa (IP), Madrid, Spain; UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
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Bell JE, Sequeira SB, Chen DQ, Haug EC, Werner BC, Browne JA. Preoperative Pain Management: Is Tramadol a Safe Alternative to Traditional Opioids Before Total Hip Arthroplasty? J Arthroplasty 2020; 35:2886-2891.e1. [PMID: 32466997 DOI: 10.1016/j.arth.2020.04.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preoperative opioid use has been associated with worse clinical outcomes and higher rates of prolonged opioid use following lower extremity arthroplasty. Tramadol has been recommended for management of osteoarthritis-related pain; however, outcomes following total hip arthroplasty (THA) in patients taking tramadol in the preoperative period have not been well described. The aim of this study is to examine the effect of preoperative tramadol use on postoperative outcomes in patients undergoing elective THA. METHODS A total of 5304 patients who underwent primary THA for degenerative hip pathology from 2008 to 2014 were identified using the Humana Claims Database. Patients were grouped by preoperative pain management modality into 3 mutually exclusive populations including tramadol, traditional opioid, or nonopioid only. A multivariate logistic regression was used to evaluate all postsurgical outcomes of interest. RESULTS Tramadol users had an increased risk of developing prolonged narcotic use (odds ratio [OR], 2.17; confidence interval [CI], 1.89-2.49; P < .001) following surgery compared to nonopioid-only users. When compared to traditional opioid use, tramadol use was associated with decreased risk of subsequent 90-day minor medical complications (OR, 0.75; CI, 0.62-0.90; P = .002), emergency department visits (OR, 0.70; CI, 0.57-0.85; P < .001), and prolonged narcotic use (OR, 0.43; CI, 0.37-0.49; P < .001). Traditional opioid use significantly increased length of stay by 0.20 days (P = .001) when compared to tramadol use. CONCLUSION Preoperative tramadol use is associated with prolonged opioid use following THA but is not associated with other postoperative complications. Patients taking tramadol preoperatively appear to have a lower risk of postoperative complications compared to patients taking traditional opioids preoperatively.
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Affiliation(s)
- Joshua E Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Sean B Sequeira
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Dennis Q Chen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Emanuel C Haug
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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Ngo J, Parker D, Meroney M, Mitchell J, Veloz O, Lee O, Cunningham KA, Wilkes D. Quantification of Opioid Prescription Practice Changes Due to Hydrocodone Combination Product Rescheduling in an Academic Pain Clinic. J Pain Res 2020; 13:2163-2168. [PMID: 32922067 PMCID: PMC7457870 DOI: 10.2147/jpr.s251386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the effect of rescheduling on prescription practices in a large academic hospital-based multidisciplinary practice comprising anesthesiologist-trained pain physicians. Patients and Methods We examined the number of HCP prescriptions written and quantity of tablets prescribed during a 6-month period prior to rescheduling and compared this with a 6-month period 1 year after rescheduling. We also examined the changes in prescription of tramadol and acetaminophen with codeine from one period to the next. Results Our pain clinic conducted 3,320 office visits during the 6-month period prior to HCP rescheduling and 6,003 office visits in the 6-month period 1 year after rescheduling. The charted data from each of these visits were used for our analysis. The mean number of tablets of HCPs prescribed per patient decreased from 318.48 in the pre-period to 242.27 tablets in the post-period, while the mean number of HCP prescriptions per patient decreased from 2.24 to 1.84. The mean number of acetaminophen with codeine tablets prescribed per patient increased from 3.46 to 15.27 in the pre- and post-period. Similarly, the mean number of tramadol tablets per patient increased from 47.33 to 61.97 in the pre- and post-period. The mean number of acetaminophen with codeine and tramadol prescriptions per patient increased from 0.02 to 0.15 and 0.38 to 0.51 in the pre- and post-period, respectively. In the 6-month post-period, fewer new patients were started on opioids compared to the 6-month pre-period, 16% and 27%, respectively. Conclusion Our study showed a significant decrease in the mean number of HCP prescriptions written per patient, as well as a decrease in the mean number of HCP tablets prescribed. Pain physicians in our clinic increased the number of prescriptions for the non-HCPs. The number of acetaminophen with codeine and tramadol tablets prescribed significantly increased. Therefore, the rescheduling of HCPs has profoundly impacted practices within this academic pain clinic.
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Affiliation(s)
- John Ngo
- Department of Anesthesiology and Pain Management, University of Texas Medical Branch, Galveston, TX, USA
| | - David Parker
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA
| | - Mathew Meroney
- Department of Anesthesiology and Pain Management, University of Florida, Gainesville, FL, USA
| | - Jasmine Mitchell
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA
| | - Oscar Veloz
- Department of Anesthesia, Mcgaw Northwestern University Medical Center, Chicago, IL, USA
| | - Oliver Lee
- Department of Anesthesia, University of Washington, Seattle, WA, USA
| | | | - Denise Wilkes
- Department of Anesthesiology and Pain Management, University of Texas Medical Branch, Galveston, TX, USA
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Passavanti MB, Piccinno G, Alfieri A, Di Franco S, Sansone P, Mangoni G, Pota V, Aurilio C, Pace MC, Fiore M. Local infiltration of tramadol as an effective strategy to reduce post-operative pain: a systematic review protocol and meta-analysis. Syst Rev 2020; 9:157. [PMID: 32660546 PMCID: PMC7359004 DOI: 10.1186/s13643-020-01419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/05/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Maria Beatrice Passavanti
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Giacomo Piccinno
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Pasquale Sansone
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Giuseppe Mangoni
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Vincenzo Pota
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Caterina Aurilio
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
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Saiz-Rodríguez M, Ochoa D, Román M, Zubiaur P, Koller D, Mejía G, Abad-Santos F. Involvement of CYP2D6 and CYP2B6 on tramadol pharmacokinetics. Pharmacogenomics 2020; 21:663-675. [PMID: 32538291 DOI: 10.2217/pgs-2020-0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study included 24 healthy volunteers who received a single 37.5 mg oral dose of tramadol. We analyzed 18 polymorphisms within CYP2D6, CYP2B6, CYP3A, COMT, ABCB1, SLC22A1 and OPRM1 genes by quantitative PCR, to study whether these polymorphisms affect its pharmacokinetics, pharmacodynamics and safety. CYP2D6 intermediate metabolizers (n = 6) showed higher tramadol plasma concentrations and lower clearance compared with normal and ultrarapid metabolizers. CYP2B6 G516T T/T (n = 2) genotype was also associated to higher tramadol plasma levels. No other polymorphism affected tramadol pharmacokinetics. Three volunteers experienced a prolonged QTc not associated with the genetic variants studied or altered phamacokinetic parameters. The correlation of CYP2B6 genotype with higher tramadol concentrations is remarkable since its influence on its elimination is also relevant and has been less studied to date. However, given our small sample size, it is important to interpret our results with caution.
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Affiliation(s)
- Miriam Saiz-Rodríguez
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Dolores Ochoa
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Manuel Román
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Pablo Zubiaur
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Dora Koller
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Gina Mejía
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain
| | - Francisco Abad-Santos
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto Teófilo Hernando, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,UICEC Hospital Universitario de La Princesa, Plataforma SCReN (Spanish Clinical Reseach Network), Instituto de Investigación Sanitaria La Princesa (IP), Madrid, 28006, Spain.,Pharmacology Department, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, 28049, Spain
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Nasiri N, Abedi L, Hajebi A, Noroozi A, Khalili M, Chegeni M, Nili S, Taheri-Soodejani M, Noroozi M, Shahesmaeili A, Sharifi H. Population Size Estimation of Tramadol Misusers in Urban Population in Iran: Synthesis of Methods and Results. ADDICTION & HEALTH 2019; 11:173-182. [PMID: 31839915 PMCID: PMC6904981 DOI: 10.22122/ahj.v11i3.240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Estimating the population who use drugs is essential for planning, monitoring, and evaluation of substance use prevention and treatment. This study aims to estimate the population who misuse tramadol in urban population in Iran. Methods We used the wisdom of the experts (WOTE) and network scale-up (NSU) methods to calculate the population of tramadol misusers in 10 provincial capitals of Iran, in 2016. The WOTE was conducted among pharmacists in drugstores and the personnel of traditional medicinal herbs stores. They guessed the best estimation of tramadol misusers population in their cities. The NSU method was conducted among the general population and participants were questioned about ever and daily, non-medical use of tramadol during last 12 months in their network. The median of the methods was used to calculate the proportion of the adult population (15-49 years old). Findings The population size of tramadol misusers in studied cities was 83300 [95% uncertainty limits (UL): 47960-256220]. This corresponded to 6.6 per 1000 (95% UL: 3.88-20.30) of the 15-49-year-old population. The projected number of tramadol misusers for all 31 provincial capitals was 118290 (95% UL: 68100-363130840) and 212440 (95% UL: 122310-653410) for all urban areas. NSU also estimated the number of people who misuse tramadol on daily basis. These numbers were 52000 (95% UL: 19940-176570) for studied cities, 73840 (95% UL: 28320-250740) for all 31 provincial capital cities, and 132610 (95% UL: 50860-450310) for all urban areas in Iran. Conclusion This study presents information on high prevalence of tramadol misuse in urban population. We need national control measures and demand reduction programs to control tramadol misuse.
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Affiliation(s)
- Naser Nasiri
- Department of Public Health, School of Public Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Leili Abedi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behaviors AND Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine AND Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Malahat Khalili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Chegeni
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sairan Nili
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Moslem Taheri-Soodejani
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Effects of Tiletamine-xylazine-tramadol Combination and its Specific Antagonist on AMPK in the Brain of Rats. J Vet Res 2019; 63:285-292. [PMID: 31276069 PMCID: PMC6598187 DOI: 10.2478/jvetres-2019-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/09/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Tiletamine-xylazine-tramadol (XFM) has few side effects and can provide good sedation and analgesia. Adenosine 5’-monophosphate-activated protein kinase (AMPK) can attenuate trigeminal neuralgia. The study aimed to investigate the effects of XFM and its specific antagonist on AMPK in different regions of the brain. Material and Methods A model of XFM in the rat was established. A total of 72 Sprague Dawley (SD) rats were randomly divided into three equally sized groups: XFM anaesthesia (M group), antagonist (W group), and XFM with antagonist interactive groups (MW group). Eighteen SD rats were in the control group and were injected intraperitoneally with saline (C group). The rats were sacrificed and the cerebral cortex, cerebellum, hippocampus, thalamus, and brain stem were immediately separated, in order to detect AMPKα mRNA expression by quantitative PCR. Results XFM was able to increase the mRNA expression of AMPKα1 and AMPKα2 in all brain regions, and the antagonist caused the opposite effect, although the effects of XFM could not be completely reversed in some areas. Conclusion XFM can influence the expression of AMPK in the central nervous system of the rat, which can provide a reference for the future development of anaesthetics for animals.
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The role of emulsion parameters in tramadol sustained-release from electrospun mats. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:1493-1501. [DOI: 10.1016/j.msec.2019.02.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/14/2019] [Accepted: 02/21/2019] [Indexed: 01/04/2023]
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Abstract
OBJECTIVE To determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids. DESIGN Observational study of administrative claims data. SETTING United States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018. PARTICIPANTS Opioid-naive patients undergoing elective surgery. MAIN OUTCOME MEASURE Risk of persistent opioid use after discharge for patients treated with tramadol alone compared with other short acting opioids, using three commonly used definitions of prolonged opioid use from the literature: additional opioid use (defined as at least one opioid fill 90-180 days after surgery); persistent opioid use (any span of opioid use starting in the 180 days after surgery and lasting ≥90 days); and CONSORT definition (an opioid use episode starting in the 180 days after surgery that spans ≥90 days and includes either ≥10 opioid fills or ≥120 days' supply of opioids). RESULTS Of 444 764 patients who met the inclusion criteria, 357 884 filled a discharge prescription for one or more opioids associated with one of 20 included operations. The most commonly prescribed post-surgery opioid was hydrocodone (53.0% of those filling a single opioid), followed by short acting oxycodone (37.5%) and tramadol (4.0%). The unadjusted risk of prolonged opioid use after surgery was 7.1% (n=31 431) with additional opioid use, 1.0% (n=4457) with persistent opioid use, and 0.5% (n=2027) meeting the CONSORT definition. Receipt of tramadol alone was associated with a 6% increase in the risk of additional opioid use relative to people receiving other short acting opioids (incidence rate ratio 95% confidence interval 1.00 to 1.13; risk difference 0.5 percentage points; P=0.049), 47% increase in the adjusted risk of persistent opioid use (1.25 to 1.69; 0.5 percentage points; P<0.001), and 41% increase in the adjusted risk of a CONSORT chronic opioid use episode (1.08 to 1.75; 0.2 percentage points; P=0.013). CONCLUSIONS People receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short acting opioids.
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Affiliation(s)
- Cornelius A Thiels
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery and Department of Health Services Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth B Habermann
- Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery and Department of Health Services Research, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Molly M Jeffery
- Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery and Department of Health Services Research, Mayo Clinic, Rochester, MN 55905, USA
- OptumLabs, Cambridge, MA 02142, USA
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Abstract
Tramadol-an atypical opioid analgesic-has a unique pharmacokinetic and pharmacodynamic profile, with opioidergic, noradrenergic, and serotonergic actions. Tramadol has long been used as a well-tolerated alternative to other drugs in moderate pain because of its opioidergic and monoaminergic activities. However, cumulative evidence has been gathered over the last few years that supports other likely mechanisms and uses of tramadol in pain management. Tramadol has modulatory effects on several mediators involved in pain signaling, such as voltage-gated sodium ion channels, transient receptor potential V1 channels, glutamate receptors, α2-adrenoceptors, adenosine receptors, and mechanisms involving substance P, calcitonin gene-related peptide, prostaglandin E2, and proinflammatory cytokines. Tramadol also modifies the crosstalk between neuronal and non-neuronal cells in peripheral and central sites. Through these molecular effects, tramadol could modulate peripheral and central neuronal hyperexcitability. Given the broad spectrum of molecular targets, tramadol as a unimodal analgesic relieves a broad range of pain types, such as postoperative, low back, and neuropathic pain and that associated with labor, osteoarthritis, fibromyalgia, and cancer. Moreover, tramadol has anxiolytic, antidepressant, and anti-shivering activities that could improve pain management outcomes. The aim of this review was to address these issues in the context of maladaptive physiological and psychological processes that are associated with different pain types.
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Affiliation(s)
- Ahmed Barakat
- Department of Medical Pharmacology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
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Simsek T, Coskun Musaoglu I, Uluat A. The effect of lidocaine and tramadol in nasal packs on pain after septoplasty. Eur Arch Otorhinolaryngol 2019; 276:1663-1669. [PMID: 30859294 DOI: 10.1007/s00405-019-05306-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study is to compare the analgesic effects of tramadol-absorbed merocel nasal packings and lidocaine-absorbed merocel nasal packings using visual analog scale (VAS) in the postoperative period in patients undergoing septoplasty operation. MATERIALS AND METHODS Our study was applied as a retrospective. Informations about the patients were accessed via their medical records. Our study was performed on 122 patients aged between 18 and 50 years. Patients were divided into three groups according to the application of lidocaine, tramadol and 0.9% NaCl on merocel nasal packings. In the postoperative period, VAS (visual analog scale) scores, side effects, additional analgesic requirements were recorded for 24 h starting from PACU (post anesthetic care unit). RESULTS There was no difference between the number of male and female patients (p > 0.05). Postoperative pain was evaluated with VAS score periodically in postoperative 5 min-24 h in all groups. When we compared the groups with each other, there was a statistically significant difference between the tramadol-lidocaine and tramadol-control group (p < 0.05). CONCLUSION Tramadol infiltrated to nasal packings decrease the need of additional analgesics in the postoperative period, increases patients' satisfaction, decreases the length of hospital stay, and as a result, reduced the rate of secondary infections.
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Affiliation(s)
- Tugce Simsek
- Department of Otorhinolaryngology and Head and Neck Surgery, Amasya University Faculty of Medicine, Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey.
| | - Isıl Coskun Musaoglu
- Department of Anesthesia and Reanimation, Ministry of Health Tekirdag Corlu State Hospital, Tekirdag, Turkey
| | - Ahmet Uluat
- Department of Otorhinolaryngology and Head and Neck Surgery, Ministry of Health Balıkesir State Hospital, Balıkesir, Turkey
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Ryan T, Hodge A, Holyoak R, Vlok R, Melhuish T, Binks M, Hurtado G, White L. Tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta‐analysis. ANZ J Surg 2019; 89:827-832. [DOI: 10.1111/ans.14920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Ryan
- Department of OrthopaedicsJohn Hunter Hospital Newcastle New South Wales Australia
- School of Medicine Sydney, Wagga Wagga Rural Clinical SchoolThe University of Notre Dame Australia Wagga Wagga New South Wales Australia
| | - Anthony Hodge
- Department of MedicineThe University of Queensland Brisbane Queensland Australia
| | - Rhys Holyoak
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Ruan Vlok
- School of Medicine Sydney, Wagga Wagga Rural Clinical SchoolThe University of Notre Dame Australia Wagga Wagga New South Wales Australia
- Department of Medicine, Wagga Wagga Rural Referral Hospital Wagga Wagga, New South Wales Australia
| | - Thomas Melhuish
- Department of Medicine, Wagga Wagga Rural Referral Hospital Wagga Wagga, New South Wales Australia
- Department of MedicineThe University of New South Wales Sydney New South Wales Australia
| | - Matthew Binks
- Department of Medicine, Wagga Wagga Rural Referral Hospital Wagga Wagga, New South Wales Australia
- Department of MedicineThe University of New South Wales Sydney New South Wales Australia
| | - Glenn Hurtado
- Department of MedicineCaboolture Hospital Caboolture Queensland Australia
| | - Leigh White
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Department of MedicineCaboolture Hospital Caboolture Queensland Australia
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Choo KH, Manikam RA, Yoong KPY, Kandasamy VA. Prophylactic metoclopramide use in trauma patients given tramadol: A randomised, double-blinded, placebo-controlled trial. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918789586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Tramadol is a common analgesia used in Emergency Department for trauma patients. However, it causes multiple side effects, most notably nausea and vomiting. Objectives: The aim of this study is to determine whether routine administration of prophylactic metoclopramide in patients receiving intravenous tramadol for injuries of extremities is beneficial. Method: A randomised, double-blinded, placebo-controlled trial was carried out on 200 trauma patients requiring tramadol for acute pain in Emergency & Trauma Department of Sarawak General Hospital. Patients were randomised into two groups, group one received metoclopramide 10 mg intravenously while group two received placebo. Nausea severity (measured on a visual analogue scale) before and after tramadol administration, number of episodes of vomiting and patients’ demographic data were recorded. Results: A total of 191 patients were recruited, in which the metoclopramide group had 96 patients while the placebo group had 95 patients. In total, 5 out of 191 patients had significant worsening of nausea severity and all were from the placebo group (5.26%). The difference was statistically significant (p = 0.029, Fisher’s exact test). Only 1 out of 191 patients vomited and was from the placebo group. No adverse reaction was reported in both groups of patients. Conclusion: Routine administration of intravenous metoclopramide may be beneficial in musculoskeletal trauma patients receiving tramadol.
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Affiliation(s)
- Kim Hoon Choo
- Emergency & Trauma Department, Sarawak General Hospital, Kuching, Malaysia
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Hatipoglu Z, Gulec E, Turktan M, Izol V, Arıdogan A, Gunes Y, Ozcengiz D. Comparative study of ultrasound-guided paravertebral block versus intravenous tramadol for postoperative pain control in percutaneous nephrolithotomy. BMC Anesthesiol 2018; 18:24. [PMID: 29454333 PMCID: PMC5816552 DOI: 10.1186/s12871-018-0479-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for renal calculi, and nephrostomy tubes lead to postoperative pain after PCNL. Regional techniques (e.g., epidural analgesia and peripheral blocks) and opioids are applied for postoperative pain treatment. The aim of this study was to compare effectiveness of ultrasound-guided paravertebral block (PVB) and tramadol on postoperative pain in patients who underwent PCNL. METHOD Fifty-three patients were included in this prospective randomized study. The patients were allocated into two groups: the PVB group (group P, n = 26) and the tramadol group (group T, n = 27). All patients were administered standard general anaesthesia. Ultrasound-guided PVB was performed at the T11- L1 levels using 0.5% bupivacaine for a total dose of 15 mL in group P. Patients in group T were intravenously administered a loading dose of 1 mg/kg tramadol. Patients in both groups were given patient-controlled analgesia. Haemodynamic parameters, visual analogue scale (VAS) scores, side effects, and complications, tramadol consumption and additional analgesic requirements of the patients were recorded after surgery. RESULTS Haemodynamic parameters were statistically similar between the groups. The VAS in group P were statistically lower than in group T. In the 24-h period after surgery, total PCA tramadol consumption was statistically lower in group P than in group T. The use of supplemental analgesic in group T was higher than in group P. CONCLUSIONS Ultrasound-guided PVB was found to be an effective analgesia compared to tramadol, and no additional complications were encountered. TRIAL REGISTRATION ClinicalTrials.gov, NCT02412930 , date of registration: March 27, 2015, retrospectively registered.
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Affiliation(s)
- Zehra Hatipoglu
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey.
| | - Ersel Gulec
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
| | - Mediha Turktan
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
| | - Volkan Izol
- Faculty of Medicine, Department of Urology, Cukurova University, Adana, Turkey
| | - Atilla Arıdogan
- Faculty of Medicine, Department of Urology, Cukurova University, Adana, Turkey
| | - Yasemin Gunes
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
| | - Dilek Ozcengiz
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Cukurova University, 01250, Adana, Turkey
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Abstract
Progress in surgical acute pain management has allowed most foot and ankle surgery to be performed in ambulatory outpatient surgical centers. Multimodal analgesia focuses on improving postoperative pain by combining pharmacologic and other modalities, addressing multiple pain mechanisms and receptor pathways while reducing adverse effects through lower doses of oral medications. Local anesthesia techniques provide excellent pain relief with few adverse events. Multimodal analgesia in foot and ankle surgery provides superior pain relief, and reduced opioid dependence and opioid-related side effects, improving patient satisfaction, safety, and timely return to function.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, The University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Nathan G Orgain
- Department of Anesthesiology, The University of Utah, SOM 3C444, 30 North 1900 East, Salt Lake City, UT 84132, USA
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Shah K, Chaudhari OB, Gupta P, Chaudhuri RH, Kamilya R, Kulkarni SS, Subbaiah S, Sorathia ZH, Billa G. Durapain in symptomatic treatment of severe acute pain: a post-marketing, prospective, multicenter, observational study - PRIME study. J Pain Res 2017; 10:1273-1278. [PMID: 28579825 PMCID: PMC5449136 DOI: 10.2147/jpr.s123772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objective To assess the effectiveness, overall tolerability, and gastrointestinal (GI) tolerability of Durapain (fixed dose combination of tramadol hydrochloride immediate release [50 mg] and diclofenac sodium sustained release [75 mg]) in symptomatic treatment of severe acute pain in physician’s routine clinical practice. Materials and methods In this prospective, multicenter, observational, post-marketing study, adult patients (aged 18–60 years) with severe acute pain were treated with tramadol hydrochloride/diclofenac sodium as per approved prescribing information. Evaluation was done at base-line, day 2, and day 5. Primary end point was pain intensity difference from baseline to day 5. Results A total of 351 patients (mean age 44.2 years; male 43%; female 57%) were included. The mean pain score was reduced from 9.2±1.09 at baseline to 2.8±1.73 at day 5 (p<0.0001). The number of patients with severe intensity of pain reduced from 100% at baseline to 18.3% at day 2 and 6.96% at day 5. According to the patient assessment, 68.36% of patients reported tolerability as “very good to good”, whereas according to physician’s assessment, “very good to good” tolerability was reported in 68.27% of patients. Five (1.43 %) patients discontinued the study because of adverse drug reaction. Five patients developed nine GI-related events of moderate intensity. Two patients developed three adverse reactions (burning sensation in urine, giddiness, and urine retention) other than GI events. No serious adverse drug reactions were reported during the study period. Conclusion Tramadol hydrochloride/diclofenac sodium is an effective and well-tolerated treatment in Indian patients with severe acute pain. Treatment with tramadol hydrochloride/diclofenac sodium provides significant pain relief on day 2 and maintained until day 5 without any serious adverse reactions.
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Affiliation(s)
| | | | | | | | | | | | - S Subbaiah
- Subbaiah's Clinic, West Mambalam, Chennai
| | | | - Gauri Billa
- Medical Services, Abbott Healthcare Pvt. Ltd, Mulund (West), Mumbai, Maharashtra, India
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Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study. BMC Anesthesiol 2017; 17:41. [PMID: 28283018 PMCID: PMC5346230 DOI: 10.1186/s12871-017-0332-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 02/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background This study was designed to compare the efficacy of an intraoperative single dose administration of tramadol and dexmedetomidine on hemodynamics and postoperative recovery profile including pain, sedation, emerge reactions in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia. Methods Seventy-seven patient, aged 2–12, undergoing adenotonsillectomy with sevoflurane anesthesia was enrolled in this study. Patients were randomly assigned to receive either intravenous 2 mg/kg tramadol (Group T; n = 39) or 1 μg/kg dexmedetomidine (Group D; n = 38) after intubation. Heart rates (HR), mean arterial pressure (MAP) were recorded before induction, at induction and every 5 min after induction. Observational pain scores (OPS), pediatric anesthesia emergence delirium (PAED) scores, percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4, and Ramsay sedation scores (RSS) were recorded on arrival to the postoperative care unit (PACU) and at 5, 10, 15, 30, 45, 60 min. Extubation time and time to reach Alderete score > 9 were recorded. Results Dexmedetomidine significantly decreased the HR and MAP 10 and 15 min after induction; increased the RSS 15, 30 and 45 min after arrival to PACU. OPS and PAED scores and percentage of patients with OPS ≥ 4 or PAED scale items 4 or 5 with an intensity of 3 or 4 in both groups did not show any significant difference. Extubation time and time to have Alderete score > 9 was significantly longer in Group D. Conclusion Both tramadol and dexmedetomidine were effective for controlling pain and emergence agitation. When compared with tramadol intraoperative hypotension, bradycardia and prolonged sedation were problems related with dexmedetomidine administration. Trial registration Retrospectively registered, registration number: ISRCTN89326952 registration date: 14.07.2016
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Dragoman MV, Grossman D, Kapp N, Huong NM, Habib N, Dung DL, Tamang A. Two prophylactic medication approaches in addition to a pain control regimen for early medical abortion < 63 days' gestation with mifepristone and misoprostol: study protocol for a randomized, controlled trial. Reprod Health 2016; 13:132. [PMID: 27733165 PMCID: PMC5062865 DOI: 10.1186/s12978-016-0246-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/03/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pain is often cited as one of the worst features of medical abortion. Further, inadequate pain management may motivate some women to seek unnecessary clinical care. There is a need to identify effective methods for pain control in this setting. METHODS/DESIGN We propose a randomized, placebo-controlled trial. 576 participants (288 nulliparous; 288 parous) from study sites in Nepal, South Africa and Vietnam will be randomly allocated to one of three treatments: (1) ibuprofen 400 mg PO and metoclopramide 10 mg PO; (2) tramadol 50 mg PO and a placebo; or (3) two placebo pills, to be taken immediately before misoprostol and repeated once four hours later. All women will be provided with supplementary analgesia for use as needed during the medical abortion. We hypothesize that women receiving prophylactic analgesia will report lower maximal pain scores in the first 8 h following misoprostol administration compared to women receiving placebos for medical abortion through 63 days' gestation. Our primary objective is to determine whether prophylactic administration of ibuprofen and metoclopramide or tramadol provides superior pain relief compared to analgesia administration after pain begins, measured during the first eight hours after misoprostol administration. Secondary objectives include identifying covariates associated with higher reported pain scores; determining any impact of the study medicines on medical abortion success; and, qualitatively exploring women's physical experiences of medical abortion, especially related to pain, and how can they be improved. Data sources include medical records, participant symptom diaries and interview data obtained on the day of enrollment, during the medical abortion, and at follow-up. Participants will be contacted via telephone on day 3 and return for follow-up will occur approximately 14 days after mifepristone, concluding study participation. A subset of 42 women will also be invited to undergo in-depth qualitative interviews following study completion. DISCUSSION Although pain is one of the most common side effects encountered with medical abortion, little is known about optimal pain management for this process. This multi-arm trial design offers an efficient approach to evaluating two prophylactic pain management regimens compared to use of pain medication as needed. TRIAL REGISTRATION ACTRN12613000017729 (Prospectively registered 8/1/2013).
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Affiliation(s)
- Monica V. Dragoman
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
- Ibis Reproductive Health, Oakland, CA USA
| | - Nathalie Kapp
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Nguyen My Huong
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Ndema Habib
- Department of Reproductive Health and Research, WHO, UNFP/UNDP/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Duong Lan Dung
- National Hospital for Obstetrics and Gynecology, Hanoi, Viet Nam
| | - Anand Tamang
- Center for Environment Health and Population Activities, Kathmandu, Nepal
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Psychiatric Comorbidity Among Egyptian Patients With Opioid Use Disorders Attributed to Tramadol. J Addict Med 2016; 10:262-8. [DOI: 10.1097/adm.0000000000000231] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Haliloglu M, Bilgen S, Menda F, Ozcan P, Ozbay L, Tatar S, Unal DO, Koner O. Analgesic efficacy of wound infiltration with tramadol after cesarean delivery under general anesthesia: Randomized trial. J Obstet Gynaecol Res 2016; 42:816-21. [PMID: 27096471 DOI: 10.1111/jog.12999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Murat Haliloglu
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Sevgi Bilgen
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Ferdi Menda
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
| | - Pinar Ozcan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bezmialem University, Istanbul, Turkey
| | - Latif Ozbay
- Department of Pharmacology, Faculty of Pharmacy, Yeditepe University, Istanbul, Turkey
| | - Sevgi Tatar
- Faculty of Pharmacy, Istanbul University, Istanbul, Turkey
| | | | - Ozge Koner
- Department of Anesthesiology, Faculty of Medicine, Yeditepe University, Istanbul, Turkey
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Hernandez-Leon A, Fernández-Guasti A, González-Trujano M. Rutin antinociception involves opioidergic mechanism and descending modulation of ventrolateral periaqueductal grey matter in rats. Eur J Pain 2015; 20:274-83. [DOI: 10.1002/ejp.720] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- A. Hernandez-Leon
- Departamento de Farmacobiología; Centro de Investigación y de Estudios Avanzados-Sede Sur; Mexico
- Laboratorio de Neurofarmacología de Productos Naturales de la Dirección de Investigaciones en Neurociencias; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz; Mexico
| | - A. Fernández-Guasti
- Departamento de Farmacobiología; Centro de Investigación y de Estudios Avanzados-Sede Sur; Mexico
| | - M.E. González-Trujano
- Laboratorio de Neurofarmacología de Productos Naturales de la Dirección de Investigaciones en Neurociencias; Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz; Mexico
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Abdel-Ghany R, Nabil M, Abdel-Aal M, Barakat W. Nalbuphine could decrease the rewarding effect induced by tramadol in mice while enhancing its antinociceptive activity. Eur J Pharmacol 2015; 758:11-5. [PMID: 25843409 DOI: 10.1016/j.ejphar.2015.03.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 01/08/2023]
Abstract
Nalbuphine, a kappa-opioid agonist and mu-opioid partial agonist, has been used as an analgesic or an adjuvant with morphine to attenuate the development of morphine dependence and rewarding effect. In this study, we investigated the effect of nalbuphine on tramadol rewarding effect and antinociception. Using the conditioned place preference (CPP) paradigm in mice, we demonstrated that co-administration of nalbuphine (7mg/kg, s.c.) with tramadol (70mg/kg, s.c.) during conditioning completely blocked the CPP induced by tramadol. Co-administration of nalbuphine blocked the increase in dopamine level in the nucleus accumbens induced by tramadol. These actions were accompanied by an increase rather than attenuation of the antinociceptive effect of tramadol. These results suggest that nalbuphine could have a great potential as a pharmacotherapy for tramadol abuse.
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Affiliation(s)
- Rasha Abdel-Ghany
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Egypt
| | - Mahmoud Nabil
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Egypt
| | - Mohamed Abdel-Aal
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Egypt
| | - Waleed Barakat
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Zagazig University, Egypt; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabuk University, Saudi Arabia.
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Abstract
BACKGROUND Tramadol dependence has been studied recently after large-scale exposure. Although tramadol dependence has increased rapidly in Egypt since 2004, no studies have evaluated the effect of high dose long-term tramadol dependence. OBJECTIVES To address the chronic sequel of tramadol dependence over at least 5 years duration with a large dose (more than 675 mg/day, three tablets or more, each tablet of 225 mg). The study was aimed to check the physical and psychiatric status during tramadol dependence and 3 months after complete treatment. METHODS The present study was applied on 79 patients with single tramadol-dependence dose of 675 mg or more for 5 years or more. We examined the physical and psychological impact of tramadol abuse before and after 3 months of stoppage of the drug. RESULTS The blood chemistry was nearly within normal parameters, although slight nonsignificant rise in liver enzymes was reported in some cases. Patients during tramadol dependence period were angry, hostile, and aggressive. On the other hand, after treatment the main problem observed was the significant increase in comorbid anxiety, depressive, and obsessive-compulsive symptoms, but no increase was found in psychotic symptoms. Tramadol-dependence dose was more important than duration of use in psychiatric illness. CONCLUSIONS Tramadol dependence on high dose could be physically safe to some limit, but psychiatrically it has many side effects.
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Marzuillo P, Calligaris L, Barbi E. Tramadol can selectively manage moderate pain in children following European advice limiting codeine use. Acta Paediatr 2014; 103:1110-6. [PMID: 25041277 DOI: 10.1111/apa.12738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 12/01/2022]
Abstract
UNLABELLED The European Medicine Agency recommendations limiting codeine use in children have created a void in managing moderate pain. We review the evidence on the pharmacokinetic, pharmacodynamic and safety profile of tramadol, a possible substitute for codeine. CONCLUSION Tramadol appears to be safe in both paediatric inpatients and outpatients. It may be appropriate to limit the current use of tramadol to monitored settings in children with risk factors for respiratory depression, subject to further safety evidence.
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Affiliation(s)
- Pierluigi Marzuillo
- M.D. Department of Women and Children and General and Specialized Surgery; Seconda Università degli Studi di Napoli; Naples Italy
| | - Lorenzo Calligaris
- M.D. Institute for Maternal and Child Health IRCCS Burlo Garofolo; Trieste Italy
| | - Egidio Barbi
- M.D. Institute for Maternal and Child Health IRCCS Burlo Garofolo; Trieste Italy
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Yargeau V, Taylor B, Li H, Rodayan A, Metcalfe CD. Analysis of drugs of abuse in wastewater from two Canadian cities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 487:722-730. [PMID: 24321387 DOI: 10.1016/j.scitotenv.2013.11.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/16/2013] [Accepted: 11/17/2013] [Indexed: 06/03/2023]
Abstract
Several drugs of abuse, including amphetamines, cocaine and its metabolite, benzoylecgonine and several opioid prescription drugs were detected in wastewater from two Canadian cities, a small community (75,000 population) and a large urban center (1.6 million population). The objective of this study was to evaluate community use of these drugs in two cities with large differences in population size and demographics. In addition, we evaluated the use of the Polar Organic Chemical Integrative Sampler (POCIS) as a monitoring tool for drugs of abuse. Heroin was not detected at either location, probably because this illicit drug is metabolized to morphine prior to excretion. Acetylcodeine and acetylmorphine were also not detected. Estimates of community consumption from wastewater analysis indicated that the most widely used drug was cocaine at a median level of consumption in the larger city of approximately 38 doses per day per 1000 people. Consumption of the substituted amphetamine, ephedrine, as well as methamphetamine was also higher in the larger city, at 21 and 1.8 doses per day per 1000 people, respectively. Use of amphetamine, MDMA and tramadol were similar in both centers, but use of oxycodone was greater in the smaller city. Use of MDMA (ecstasy) peaked on weekends. Ketamine was detected in wastewater from the larger city; the first report of abuse of this veterinary anesthetic in a North American city. POCIS sampling rates were determined for the first time for 7 of the target compounds. Comparing the time weighted average concentrations estimated from POCIS data to the concentrations obtained from 24-h composite samples, the data were generally comparable, except for some compounds which were not detected in POCIS deployed in the untreated wastewater, probably because of biofouling or accumulation of debris on the cages containing the POCIS. This study indicates that the size and demographics of population centers can influence the patterns of abuse of drugs.
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Affiliation(s)
- Viviane Yargeau
- Department of Chemical Engineering, McGill University, Montreal, QC, Canada.
| | - Bryanne Taylor
- Water Quality Centre, Trent University, Peterborough, ON, Canada
| | - Hongxia Li
- Water Quality Centre, Trent University, Peterborough, ON, Canada
| | - Angela Rodayan
- Department of Chemical Engineering, McGill University, Montreal, QC, Canada
| | - Chris D Metcalfe
- Water Quality Centre, Trent University, Peterborough, ON, Canada
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Dooney NM, Sundararajan K, Ramkumar T, Somogyi AA, Upton RN, Ong J, O'Connor SN, Chapman MJ, Ludbrook GL. Pharmacokinetics of tramadol after subcutaneous administration in a critically ill population and in a healthy cohort. BMC Anesthesiol 2014; 14:33. [PMID: 24914400 PMCID: PMC4049400 DOI: 10.1186/1471-2253-14-33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 04/15/2014] [Indexed: 11/14/2022] Open
Abstract
Background Tramadol is an atypical centrally acting analgesic agent available as both oral and parenteral preparations. For patients who are unable to take tramadol orally, the subcutaneous route of administration offers an easy alternative to intravenous or intramuscular routes. This study aimed to characterise the absorption pharmacokinetics of a single subcutaneous dose of tramadol in severely ill patients and in healthy subjects. Methods/design Blood samples (5 ml) taken at intervals from 2 minutes to 24 hours after a subcutaneous dose of tramadol (50 mg) in 15 patients (13 male, two female) and eight healthy male subjects were assayed using high performance liquid chromatography. Pharmacokinetic parameters were derived using a non-compartmental approach. Results There were no statistically significant differences between the two groups in the following parameters (mean ± SD): maximum venous concentration 0.44 ± 0.18 (patients) vs. 0.47 ± 0.13 (healthy volunteers) mcg/ml (p = 0.67); area under the plasma concentration-time curve 177 ± 109 (patients) vs. 175 ± 75 (healthy volunteers) mcg/ml*min (p = 0.96); time to maximum venous concentration 23.3 ± 2 (patients) vs. 20.6 ± 18.8 (healthy volunteers) minutes (p = 0.73) and mean residence time 463 ± 233 (patients) vs. 466 ± 224 (healthy volunteers) minutes (p = 0.97). Conclusions The similar time to maximum venous concentration and mean residence time suggest similar absorption rates between the two groups. These results indicate that the same dosing regimens for subcutaneous tramadol administration may therefore be used in both healthy subjects and severely ill patients. Trial registration ACTRN12611001018909
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Affiliation(s)
- Neil M Dooney
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia ; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Tharapriya Ramkumar
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Richard N Upton
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia ; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia ; Discipline of Pharmacometrics, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Jennifer Ong
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Stephanie N O'Connor
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia ; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Marianne J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia ; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Guy L Ludbrook
- Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine, Royal Adelaide Hospital, Adelaide, SA 5000, Australia ; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
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The investigation of tramadol dependence with no history of substance abuse: a cross-sectional survey of spontaneously reported cases in Guangzhou City, China. BIOMED RESEARCH INTERNATIONAL 2013; 2013:283425. [PMID: 24151592 PMCID: PMC3787562 DOI: 10.1155/2013/283425] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/14/2013] [Accepted: 08/14/2013] [Indexed: 11/17/2022]
Abstract
The study was to survey and assess the drug dependence and abuse potential of tramadol with no history of substance abuse. Subjects of tramadol dependence with no prior history of substance abuse were surveyed by interview. Physical dependence of tramadol was assessed using 10 items opiate withdrawal scale (OWS), and psychological dependence was assessed by Addiction Research Center Inventory-Chinese Version (ARCI-CV). Twenty-three male subjects (the median age was 23.4 ± 4.1 years) referred to the addiction unit in Medical Hospital of Guangzhou with tramadol abuse problems were included in this cross-sectional study. The control group included 87 heroin addicts, 60 methamphetamine (MA) abusers, and 50 healthy men. The scores of OWS of tramadol were 0.83-2.30; the mean scores of identifying euphoric effects-MBG, sedative effects-PCAG, and psychotomimetic effects-LSD of ARCI were 8.96 ± 3.08, 6.52 ± 3.25, and 6.65 ± 2.50, respectively, F = 4.927, P < 0.001. Scores of MBG scale in tramadol did not differ from those in heroin and MA groups (P > 0.05) but were higher than those in healthy men (P < 0.05). Tramadol with no history of substance abuse has a clear risk of producing high abuse potential under the long-term infrequent abuse and the high doses.
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Radbruch L, Glaeske G, Grond S, Münchberg F, Scherbaum N, Storz E, Tholen K, Zagermann-Muncke P, Zieglgänsberger W, Hoffmann-Menzel H, Greve H, Cremer-Schaeffer P. Topical Review on the Abuse and Misuse Potential of Tramadol and Tilidine in Germany. Subst Abus 2013; 34:313-20. [DOI: 10.1080/08897077.2012.735216] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Flôr PB, Yazbek KVB, Ida KK, Fantoni DT. Tramadol plus metamizole combined or not with anti-inflammatory drugs is clinically effective for moderate to severe chronic pain treatment in cancer patients. Vet Anaesth Analg 2013; 40:316-27. [DOI: 10.1111/vaa.12023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 02/27/2012] [Indexed: 11/30/2022]
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Cekıc B, Dogan U, Geze S, Erturk E, Besır A. Comparison of The Postoperative Analgesic Effects of Wound Infiltration with Tramadol and Levobupivacaine in Children Undergoing Inguinal Hernia and
Undescended Testis Surgery. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abuse liability and reinforcing efficacy of oral tramadol in humans. Drug Alcohol Depend 2013; 129:116-24. [PMID: 23098678 PMCID: PMC3594406 DOI: 10.1016/j.drugalcdep.2012.09.018] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tramadol, a monoaminergic reuptake inhibitor, is hepatically metabolized to an opioid agonist (M1). This atypical analgesic is generally considered to have limited abuse liability. Recent reports of its abuse have increased in the U.S., leading to more stringent regulation in some states, but not nationally. The purpose of this study was to examine the relative abuse liability and reinforcing efficacy of tramadol in comparison to a high (oxycodone) and low efficacy (codeine) opioid agonist. METHODS Nine healthy, non-dependent prescription opioid abusers (6 male and 3 female) participated in this within-subject, randomized, double blind, placebo-controlled study. Participants completed 14 paired sessions (7 sample and 7 self-administration). During each sample session, an oral dose of tramadol (200 and 400 mg), oxycodone (20 and 40 mg), codeine (100 and 200 mg) or placebo was administered, and a full array of abuse liability measures was collected. During self-administration sessions, volunteers were given the opportunity to work (via progressive ratio) for the sample dose or money. RESULTS All active doses were self-administered; placebo engendered no responding. The high doses of tramadol and oxycodone were readily self-administered (70%, 59% of available drug, respectively); lower doses and both codeine doses maintained intermediate levels of drug taking. All three drugs dose-dependently increased measures indicative of abuse liability, relative to placebo; however, the magnitude and time course of these and other pharmacodynamic effects varied qualitatively across drugs. CONCLUSIONS This study demonstrates that, like other mu opioids, higher doses of tramadol function as reinforcers in opioid abusers, providing new empirical data for regulatory evaluation.
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Mongin G, Yakusevich V, Köpe A, Shostak N, Pikhlak E, Popdán L, Simon J, Navarro C, Fortier L, Robertson S, Bouchard S. Efficacy and Safety Assessment of a Novel Once-Daily Tablet Formulation of Tramadol : A Randomised, Controlled Study versus Twice-Daily Tramadol in Patients with Osteoarthritis of the Knee. Clin Drug Investig 2012; 24:545-58. [PMID: 17523716 DOI: 10.2165/00044011-200424090-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To compare the 24-hour sustained efficacy and safety of a new tramadol once-daily formulation (tramadol OAD) using Contramid((R)) controlled-release technology with a marketed twice-daily formulation (tramadol BID). PATIENTS, DESIGN AND SETTING: 431 patients with osteoarthritis of the knee were enrolled in this randomised, double-blind, multicentre, parallel study. After titration to optimum dose (range 100-400mg), patients received medication for 12 weeks. MAIN OUTCOME MEASURES AND RESULTS Efficacy evaluations included: Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores (pain, stiffness, physical function and global), daily efficacy ratings (post-dose: tramadol OAD 24 hours; tramadol BID 12 hours), pain ratings over 24 hours, and patient and investigator overall ratings. Non-inferiority was demonstrated for the primary endpoint, mean percentage change in WOMAC pain score from baseline to week 12 (tramadol OAD 58%; tramadol BID 59%) [95% CI -7.67, 3.82]. The median optimum dose received was 200mg (both treatments). In 73% of patients, pain was mild to absent at the end of the dosing interval for both treatments (tramadol OAD 24 hours; tramadol BID 12 hours). Pain ratings over 24 hours were similar between groups, indicating 24-hour sustained efficacy for tramadol OAD. More tramadol BID patients reported dizziness/vertigo (37% vs 26%), vomiting (14% vs 8%) and headache (18% vs 13%) while tramadol OAD patients reported more somnolence (30% vs 21%). CONCLUSIONS This study demonstrated that this novel tramadol OAD formulation provides sustained analgesic efficacy over the entire 24-hour dosing interval and a clinically favourable safety profile, both of which will provide a clear clinical benefit.
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Pharmacodynamic profile of tramadol in humans: influence of naltrexone pretreatment. Psychopharmacology (Berl) 2012; 223:427-38. [PMID: 22623016 PMCID: PMC3439600 DOI: 10.1007/s00213-012-2739-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/20/2012] [Indexed: 10/28/2022]
Abstract
RATIONALE Tramadol is a prescription analgesic that activates mu opioid and monoamine receptor systems. Tramadol is thought to have limited abuse potential compared to mu opioid agonists, but laboratory data indicate that it shares some of their pharmacodynamic effects. OBJECTIVES This study evaluated the effect of mu opioid receptor blockade with naltrexone on the pharmacodynamic action of tramadol in humans. METHODS This inpatient, double-blind, randomized, within-subject study examined the effects of oral placebo, tramadol (87.5, 175, and 350 mg), and hydromorphone (4 and 16 mg; positive control) after 1 h pretreatment with oral naltrexone (0 and 50 mg). Ten recreational opioid users completed the study. Pharmacodynamic effects were measured before and for 7 h after initial drug administration. RESULTS Lower doses of tramadol and hydromorphone were generally placebo-like. Hydromorphone (16 mg) produced prototypic mu opioid agonist-like effects that were blocked by naltrexone. Tramadol (350 mg) produced miosis and increased ratings of "Good Effects" and "Liking" but also increased ratings of "Bad Effects." Naltrexone reversed tramadol-induced physiological effects and mydriasis emerged, but unlike results with hydromorphone, naltrexone only partially attenuated tramadol's positive subjective effects and actually enhanced several unpleasant subjective ratings. CONCLUSIONS Naltrexone can be used to disentangle the mixed neuropharmacological actions of tramadol. High-dose tramadol produces a mixed profile of effects. These data suggest that both mu and non-mu opioid actions play a role in tramadol's subjective profile of action.
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Uberall MA, Mueller-Schwefe GHH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28:1617-34. [PMID: 22970658 DOI: 10.1185/03007995.2012.726216] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To demonstrate non-inferior/superior efficacy of flupirtine modified release (MR) compared with tramadol/placebo for the management of moderate to severe chronic low back pain (LBP). RESEARCH DESIGN Randomized, double-blind, active-/placebo-controlled double-dummy multicenter study, performed in 31 German study centers. LBP patients (n = 363) with moderate pain intensity were randomized 1:1:1 to receive flupirtine MR 400 mg, tramadol extended release (ER) 200 mg, or matching placebo (each given OD in the evening) over 4 weeks. CLINICAL TRIAL REGISTRATION EudraCT 2009-013268-38. MAIN OUTCOME MEASURES Primary endpoint was change from baseline in the LBP intensity index (LBPIX; 11-point NRS) at week 4; last observation carried forward was used to impute missing scores. RESULTS Least square (LS) mean ± SD LBPIX changes from baseline at week 4 were clinically significant for all three treatment groups of the intent-to-treat (ITT) and the per-protocol (PP) population (n = 326/276): placebo (n = 110/96): -1.81 ± 1.65/-1.77 ± 1.59; flupirtine MR (n = 109/95): -2.23 ± 1.73/-2.28 ± 1.68; and tramadol ER (n = 107/85): -1.92 ± 1.84/2.03 ± 1.83 (p < 0.001 for each). ITT/PP treatment effects for flupirtine MR were non-inferior when compared with tramadol ER and superior when compared with placebo (p = 0.003/0.033). Significantly more ITT patients treated with flupirtine MR (59.6/37.6 showed a ≥30/50% LBPIX relief in comparison to placebo (46.4/24.6%; p vs. flupirtine MR: 0.049/0.037). Treatment contrasts for tramadol failed to reach significance vs. placebo. Within the safety population (n = 355), flupirtine MR (n = 119) was associated with a significantly lower incidence of treatment emergent AEs (TEAEs; 21.0%) and TEAE-related study discontinuations (3.4%) than tramadol ER (n = 116; 34.5/12.0%; p = 0.039/0.017) and exhibited an overall safety/tolerability profile non-inferior to placebo (n = 120; 15.8/3.3%; p = ns for each). Major limitations of this study were the short treatment duration, the comparison of different drug classes and the lack of a titration phase. CONCLUSIONS The analgesic efficacy of flupirtine MR 400 mg OD was comparable to that of tramadol ER 200 mg OD and superior to that of placebo.
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Affiliation(s)
- Michael A Uberall
- Institute for Neurological Sciences, Algesiology and Pediatrics, Nuernberg, Germany.
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Ekmekçi P, Beriat GK, Bengisun ZK, Kazbek BK, Duman P, Süer H. The efficacy of submucosal tramadol in the postoperative treatment of pain following septoplasty operations. Indian J Otolaryngol Head Neck Surg 2012; 65:12-5. [PMID: 24381911 DOI: 10.1007/s12070-012-0571-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/24/2012] [Indexed: 11/24/2022] Open
Abstract
Tramadol is a centrally acting opioid which is effective for moderate-severe pain and is being used for various acute and chronic pain scenarios. The primary endpoint of this controlled, randomized double blind study was to evaluate the effect of submucosal tramadol on VAS scores after septoplasty operations and secondary endpoint was to investigate the effects on total opioid and additional analgesic consumption and patient satisfaction. 60 patients scheduled for septoplasty under general anaesthesia were enrolled. In Group T, at the end of surgery following hemostasis, 2 mg/kg tramadol was applied as submucosal infiltration to both surgical sites, 2 ml (total 4 ml), by the surgeon. In Group P, at the end of surgery following hemostasis, 2 ml isotonic solution (total 4 ml) was applied as submucosal infiltration to both surgical sites by the surgeon. Total opioid consumption, VAS scores, patient satisfaction was evaluated at the end of 24 h VAS values were higher in Group P on the first and second postoperative hours. Patient controlled analgesia demand and delivery values were higher in Group P on the postoperative 1, 2, 4, 6, 12 and 24th hours. Patient satisfaction was higher and opioid consumption was lower in Group T compared to Group P. There was no difference in additional analgesic consumption between two groups. The results show that patients receiving tramadol had lower VAS scores compared with the placebo groups postoperatively.
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Affiliation(s)
- Perihan Ekmekçi
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Güçlü Kaan Beriat
- Department of Ear, Nose and Throat, Ufuk University Dr Rıdvan Ege Hospital, Ankara, Turkey
| | - Züleyha Kazak Bengisun
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Baturay Kansu Kazbek
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Peyami Duman
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
| | - Hikmet Süer
- Department of Anesthesiology and Reanimation, Ufuk University Dr Rıdvan Ege Hospital, Konya Yolu Mevlana Blv. 86/88, Balgat, Ankara, Turkey
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Jabalameli M, Safavi M, Honarmand A, Saryazdi H, Moradi D, Kashefi P. The comparison of intraincisional injection tramadol, pethidine and bupivacaine on postcesarean section pain relief under spinal anesthesia. Adv Biomed Res 2012; 1:53. [PMID: 23326784 PMCID: PMC3544092 DOI: 10.4103/2277-9175.100165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/18/2012] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Mitra Jabalameli
- Department of Anesthesiology and Intensive Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Hassan SS, Ahmed A, Rai M, Kalappa TM. Analgesic efficacy of tramadol and butorphanol in mandibular third molar surgery: a comparative study. J Contemp Dent Pract 2012; 13:364-70. [PMID: 22918011 DOI: 10.5005/jp-journals-10024-1152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Butorphanol tartrate, a mixed synthetic agonistantagonist opioid analgesic has been used for management of postoperative pain in minor and major surgical procedures.(14,20) Tramadol hydrochloride is a centrally acting opioid which is effectively used in postoperative pain in various minor and major surgeries. MATERIALS AND METHODS Twenty subjects selected randomly received butorphanol tartrate 1 mg intramuscular and 20 subjects received tramadol hydrochloride 50 mg intramuscular after the removal of mandibular third molars. Time of injection, amount of anesthetic injected, duration of surgery, adverse effects were recorded.(21) RESULTS The mean amount of LA administered in butorphanol group was 2.6450 ml and in tramadol group was 2.640 ml respectively, the mean duration for surgery was 56.75 and 53.5 minutes for butorphanol and tramadol groups respectively which was statistically not significant. Pain assessment was done with VAS which showed mean of 19.2 and 15.5 mm (p = 0.001) which was significant for butorphanol and tramadol respectively after 12 hours. The mean time for rescue medication requirement was 5.9 hours (for tramadol) and 8.4 hours (for butorphanol). Effective analgesic activity was seen by butorphanol 1 mg intramuscular then tramadol 50 mg. CONCLUSION Butorphanol 1 mg was more effective than tramadol 50 mg in respect to postoperative analgesia.
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Affiliation(s)
- Syed Sirajul Hassan
- Assistant Professor, Department of Oral and Maxillofacial Surgery Farooqia Dental College, Mysore, Karnataka, India.
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Ortner C, Steiner I, Margeta K, Schulz M, Gustorff B. Dose response of tramadol and its combination with paracetamol in
UVB
induced hyperalgesia. Eur J Pain 2012; 16:562-73. [DOI: 10.1016/j.ejpain.2011.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C.M. Ortner
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
- Department of Anesthesiology and Pain MedicineUniversity of Washington Seattle WA USA
| | - I. Steiner
- Institute for Medical StatisticsMedical University Vienna Vienna Austria
| | - K. Margeta
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
| | - M. Schulz
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
| | - B. Gustorff
- Department of AnesthesiologyGeneral Intensive Care and Pain ControlVienna Human Pain Research GroupMedical University Vienna Vienna Austria
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Vadivelu N, Timchenko A, Huang Y, Sinatra R. Tapentadol extended-release for treatment of chronic pain: a review. J Pain Res 2011; 4:211-8. [PMID: 21887118 PMCID: PMC3160834 DOI: 10.2147/jpr.s14842] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Indexed: 11/23/2022] Open
Abstract
Tapentadol is a centrally acting analgesic with a dual mechanism of action of mu receptor agonism and norepinephrine reuptake inhibition. Tapentadol immediate-release is approved by the US Food and Drug Administration for the management of moderate-to-severe acute pain. It was developed to decrease the intolerability issue associated with opioids. Tapentadol extended-release has a 12-hour duration of effect, and has recently been evaluated for pain in patients with chronic osteoarthritis, low back pain, and pain associated with diabetic peripheral neuropathy. Tapentadol extended-release was found to provide safe and highly effective analgesia for the treatment of chronic pain conditions, including moderate-to-severe chronic osteoarthritis pain and low back pain. Initial trials demonstrating efficacy in neuropathic pain suggest that tapentadol has comparable analgesic effectiveness and better gastrointestinal tolerability than opioid comparators, and demonstrates effectiveness in settings of inflammatory, somatic, and neuropathic pain. Gastrointestinal intolerance and central nervous system effects were the major adverse events noted. Tapentadol will need to be rigorously tested in chronic neuropathic pain, cancer-related pain, and cancer-related neuropathic pain.
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Affiliation(s)
- Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT
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Buynak R, Shapiro DY, Okamoto A, Van Hove I, Rauschkolb C, Steup A, Lange B, Lange C, Etropolski M. Efficacy and safety of tapentadol extended release for the management of chronic low back pain: results of a prospective, randomized, double-blind, placebo- and active-controlled Phase III study. Expert Opin Pharmacother 2010; 11:1787-804. [PMID: 20578811 DOI: 10.1517/14656566.2010.497720] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of tapentadol extended release (ER) for the management of moderate to severe chronic low back pain. RESEARCH DESIGN Patients (N = 981) were randomized 1:1:1 to receive tapentadol ER 100 - 250 mg b.i.d., oxycodone HCl controlled release (CR) 20 - 50 mg b.i.d., or placebo over 15 weeks (3-week titration period, 12-week maintenance period). MAIN OUTCOME MEASURES Efficacy was assessed as change from baseline in average pain intensity (11-point NRS) at week 12 of the maintenance period and throughout the maintenance period; last observation carried forward was used to impute missing pain scores. Adverse events (AEs) were monitored throughout the study. RESULTS Tapentadol ER significantly reduced average pain intensity versus placebo at week 12 (least squares mean difference vs placebo [95% confidence interval], -0.8 [-1.22, -0.47]; p < 0.001) and throughout the maintenance period (-0.7 [-1.06,-0.35]; p < 0.001). Oxycodone CR significantly reduced average pain intensity versus placebo at week 12 (-0.9 [-1.24,-0.49]; p < 0.001) and throughout the maintenance period (-0.8 [-1.16,-0.46]; p < 0.001). Tapentadol ER was associated with a lower incidence of treatment-emergent AEs (TEAEs) than oxycodone CR. Gastrointestinal TEAEs, including constipation, nausea, and vomiting, were among the most commonly reported TEAEs (placebo, 26.3%; tapentadol ER, 43.7%; oxycodone CR, 61.9%). The odds of experiencing constipation or the composite of nausea and/or vomiting were significantly lower with tapentadol ER than with oxycodone CR (both p < 0.001). CONCLUSIONS Tapentadol ER (100 - 250 mg b.i.d.) effectively relieved moderate to severe chronic low back pain over 15 weeks and had better gastrointestinal tolerability than oxycodone HCl CR (20 - 50 mg b.i.d.).
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Affiliation(s)
- Robert Buynak
- Northwest Indiana Center for Clinical Research, Indiana, USA
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Kongara K, Chambers JP, Johnson CB. Electroencephalographic responses of tramadol, parecoxib and morphine to acute noxious electrical stimulation in anaesthetised dogs. Res Vet Sci 2010; 88:127-33. [DOI: 10.1016/j.rvsc.2009.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Revised: 12/23/2008] [Accepted: 05/12/2009] [Indexed: 11/29/2022]
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Hartrick CT. Tapentadol immediate release for the relief of moderate-to-severe acute pain. Expert Opin Pharmacother 2010; 10:2687-96. [PMID: 19795998 DOI: 10.1517/14656560903313734] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tapentadol is a novel, centrally acting analgesic with two mechanisms of action: micro-opioid receptor agonism and norepinephrine reuptake inhibition. It has demonstrated broad analgesic efficacy across multiple pain models. This article reviews the clinical development of tapentadol immediate release (IR), including results from Phase II and III clinical trials that evaluated the efficacy and safety of tapentadol IR in patients with moderate-to-severe acute pain. In clinical studies in patients with moderate-to-severe acute postoperative pain, osteoarthritis pain and/or low back pain, tapentadol IR 50, 75 or 100 mg every 4 - 6 h has demonstrated analgesic efficacy similar to that observed with the micro-opioid receptor agonist oxycodone HCl IR 10 or 15 mg every 4 - 6 h. However, at doses providing comparable analgesic efficacy, tapentadol IR has been associated with significantly lower incidences of nausea and/or vomiting and constipation, and a significantly lower rate of treatment discontinuation compared with oxycodone IR. The observed efficacy across different pain models and favorable gastrointestinal tolerability profile associated with tapentadol IR indicate that this novel analgesic is an attractive treatment option for the relief of moderate-to-severe acute pain.
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Affiliation(s)
- Craig T Hartrick
- Anesthesiology Research, William Beaumont Hospital, Department of Anesthesiology, 3601 W. 13 Mile Rd., Royal Oak, MI 48073, USA.
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