Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery

Abstract

This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics. In a randomized, controlled, single-blinded procedure, 87 men and women aged 18-44years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery. Time from the end of operation until first rescue pill (400mg Ibuprofen tablet) differed significantly between the M + S group (193min) and the C group (110min) (p = 0.001) as well as the M + T group (157min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1mg/kg tramadol under midazolam sedation. The lack of significant difference between the study and placebo groups indicates that tramadol at 1mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.