Addition Of Tramadol Research Articles

Magnesium sulfate versus tramadol as adjuvants to local anesthetics in sciatic nerve block for lower extremities surgeries

Background The aim of this study was to compare the effect of addition of tramadol and magnesium sulfate as adjuvants to local anesthetics lidocaine 2% and bupivacaine 0.5% in sciatic nerve block classic posterior approach. Patients and methods A total of 90 ASA I or II patients, aged 17–50 years, scheduled for lower extremities surgeries under sciatic nerve block classic posterior approach were randomized into three equal groups. All groups received 20 ml of local anesthetics, which consisted of 10 ml bupivacaine 0.5% and 8 ml lidocaine 2% mixed with 2 ml saline in the control (C) group, 2 ml of 150 mg magnesium sulfate made in saline in the magnesium (M) group, and 2 ml of 100 mg tramadol in the tramadol (T) group. The onset and duration of both sensory and motor blocks, the intraoperative pain assessment by visual analogue scale, intraoperative analgesic requirements, postoperative pain by visual analogue scale, time to first analgesic request after surgery, postoperative diclofinac consumption, and adverse effects were assessed. Results The onsets of sensory and motor blocks were rapid in the M group, then C group, and lastly, T group. Much more time was needed for group T until sensory and motor blocks faded away followed by group M and then group C. There was a significant delay in the time of first analgesic request in groups M and T when compared with group C. There was a significant decrease in the total dose of diclofinac consumption in groups T and M in comparison with group C, where the patients consumed more analgesia. Conclusion Magnesium sulfate and tramadol as adjuncts to local anesthetics increase the duration of sensory and motor sciatic nerve block. The time for first rescue analgesia was longer in groups M and T, and they both showed decreased postoperative analgesic consumption.

537P A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain

Background Thoracoscopic surgery (TS) has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aim of this study was to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS). Methods A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on NRS score. Results Of the 524 patients, mild pain was noted in 87% on the day of the operation and in 75.6% on ambulation. The mean NRS score was 1.83 6 1.49 on the day of the operation and 2.73 6 1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Reduction of pain with an NRS score of 2: 1 was significant with the addition of pentazocine hydrochloride (p < 0.01) and flurbiprofen (p < 0.01). Interestingly, the addition of tramadol was borderline efficacious (p = 0.05) in patients with an NRS score of > 3 on ambulation. Conclusions A small number of patients have moderate to severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of 2: 3. Legal entity responsible for the study N/A Funding N/A Disclosure All authors have declared no conflicts of interest.

Confining nanohybrid of CdTe quantum dots and cytochrome P450 2D6 in macroporous ordered siliceous foam for drug metabolism

In this work, a simple and accurate in vitro drug metabolism strategy was proposed by using macroporous ordered siliceous foam (MOSF) as a nanoreactor for confining the nanohybrid of CdTe quantum dots (QDs) and cytochrome P450 2D6 (CYP2D6). After CYP2D6 was coupled to QDs through the carbodiimide coupling chemistry, the resulting nanohybrid of CYP2D6/QDs exhibited fluorescence emission at 645nm, which could be used as a photocatalyst for drug metabolism. The energy level of CYP2D6 was located between the conduction band (CB) and valence band (VB) of QDs, which provided the possibility of the electron transferring from the CB of QDs to CYP2D6. Tramadol was chosen as the model substrate. Under the irradiation of a white-light, the photocurrent increased with the addition of tramadol in a wide linear range from 4.0μM to 100μM. The apparent Michaelis–Menten constant was measured to be 3.6μM. The high performance liquid chromatography coupled with mass spectrometry (HPLC–MS) confirmed the production of metabolite of o-desmethyltramadol. Such nanoreactor provided a suitable environment to confine a mass of enzyme, as well as to maintain their catalytic activities for highly effective drug metabolic reactions. This showed promising potential for immobilizing various enzymes and other biomolecules in biomimetic metabolism study.

A comparison of ropivacaine, ropivacaine with tramadol and ropivacaine with midazolam for post-operative caudal epidural analgesia.

Background and Aims:Caudal epidural analgesia is the most commonly used method of post-operative analgesia in children undergoing subumbilical surgeries. Many additive drugs have been used to prolong the post-operative analgesia. The aim of this study was to compare the efficacy of tramadol or midazolam addition to caudal ropivacaine for post-operative analgesia in children undergoing subumbilical surgeries.Methods:In this prospective, randomised, double-blinded comparative study, sixty children of either gender, in the age group of 1–5 years and scheduled for elective subumbilical surgeries were randomly divided into three groups of twenty each. Children in Group R received an epidural injection of 1 mL/kg of 0.2% plain ropivacaine whereas children in Group RT received an epidural injection of 2 mg/kg of tramadol plus 1 mL/kg of 0.2% ropivacaine and Group RM received an epidural injection of 50 μg/kg midazolam plus 1 mL/kg of 0.2% ropivacaine. The primary outcome variable was the duration of time to rescue analgesia. The secondary outcome variables were motor block, sedation score and urinary retention. Statistical comparison among the three groups was performed using one-way ANOVA with post hoc analysis using Bonferroni. For qualitative variables, Chi-square test was used. Statistical significance was defined as P < 0.05.Results:The mean duration of time to rescue analgesia was significantly longer (P < 0.001) in Group RT (913 ± 315.5 min) and Group RM (769.2 ± 331.9 min) compared to Group R (437.75 ± 75.68 min). However, there was no significant difference in the duration of time to rescue analgesia between RT and RM groups. Motor block and sedation scores were comparable between groups.Conclusions:The addition of tramadol or midazolam to caudal epidural ropivacaine prolongs the duration of analgesia without causing significant side effects.

Caudal bupivacaine plus ketamine compared with bupivacaine plus tramadol for postoperative analgesia in children

Background Caudal epidural block has been used commonly in pediatric postoperative pain management. However, the analgesic effect of caudal of bupivacaine lasts for 4-12 h. Aim The aim of this study was to compare the analgesic efficacy of the coadministration of tramadol (2 mg/kg) and ketamine (0.25 mg/kg) on the duration of caudal block produced by 0.25% bupivacaine 0.75 ml/kg on postoperative pain after an elective subumbilical surgery in children. Settings and design This is a controlled, randomized, single-blinded study. Patients and methods This study was carried out on 40 children between 2 and 12 years of age, ASA grade 1, of both sexes in Tanta University after obtaining the approval of the local hospital organization and parents' consent. The patients were divided into two equal groups. The patients in the bupivacaine plus ketamine group (group 1) received caudal bupivacaine 0.25%, 0.75 ml/kg mixed with ketamine 0.25 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg. The patients in the bupivacaine plus tramadol group (group 2) were administered caudal bupivacaine 0.25%, 0.75 ml/kg mixed with tramadol 2 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg. Statistical analysis Mean and SD were calculated as numerical data. Continuous variables were compared using the unpaired Student's t -test. Nominal nonparametric data were analyzed using the χ 2 -test. Results Patients were monitored over the first 24 h postoperatively to assess analgesia using the All India Institute of Medical Science (AIIMS) objective pain discomfort scale and associated hemodynamic and respiratory changes. Our results showed that the addition of tramadol in group 2 significantly prolonged the analgesic effect of bupivacaine; also, there was hemodynamic stability and pain scores indicated minimal pain. Conclusion Caudal epidural tramadol has been proven to be safe at the concentration used and to prolong bupivacaine's analgesic duration postoperatively in children.

Nanohybrids of quantum dots and cytochrome P450 for light-driven drug metabolism

In this work, nanohybrids of CdTe quantum dots (QDs) and cytochrome P450 2D6 (CYP2D6) prepared by covalent binding of CYP2D6 to QDs were used as photocatalysts for drug metabolism. As a proof-of-concept of the light-driven drug metabolism, tramadol was chosen as the substrate. As control, the high performance liquid chromatography coupled with mass spectrometry (HPLC–MS) was used to confirm the production of metabolites. Under irradiation with a white-light, the catalytic cycle of P450-mediated oxygenation reactions occurred with the formation of radical species on QDs, which immediately activated the proximity of the bound P450 enzyme and transferred electrons from the conduction band (CB) of CdTe QDs to CYP2D6. This light-driven catalytic reaction via nanohybrids was comparable to the native biological metabolism by CYP2D6 isozyme microsomes with CYP reductase (CPR) using the enzyme cofactor nicotinamide-adenine dinucleotide phosphate (NADPH) as electron donor. Furthermore, a photoelectrochemical platform was designed for in-situ monitoring the metabolic reactions. Upon addition of tramadol, the photocurrent increased due to the electron transfer from the CB of CdTe QDs to CYP2D6. The apparent Michaelis–Menten constant was thus easily measured to be 1.35μM. This enzyme-based photoelectrochemical platform showed accepted stability and great potential for studies on drug metabolism in vitro.

Regional Anesthesia for Postoperative Pain Control

Regional Anesthesia for Postoperative Pain Control

Does the addition of tramadol and ketamine to ropivacaine prolong the axillary brachial plexus block?

Background and Objectives. A prospective, randomized, controlled, double-blind clinical trial to assess the effect of tramadol and ketamine, 50 mg, added to ropivacaine in brachial plexus anesthesia. Methods. Thirty-six ASA physical statuses I and II patients, between 18 and 60 years of age, scheduled for forearm and hand surgery under axillary brachial plexus block, were allocated to 3 groups. Group R received 0.375% ropivacaine in 40 mL, group RT received 0.375% ropivacaine in 40 mL with 50 mg tramadol, and group RK received 0.375% ropivacaine in 40 mL with 50 mg ketamine for axillary brachial plexus block. The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events (nausea, vomiting, and feeling uncomfortable) were recorded. Results. The onset time of sensorial block was the fastest in ropivacaine + tramadol group. Duration of sensorial and motor block was the shortest in the ropivacaine + tramadol group. Duration of analgesia was significantly longer in ropivacaine + tramadol group. Conclusion. We conclude that when added to brachial plexus analgesia at a dose of 50 mg, tramadol extends the onset and duration time of the block and improves the quality of postoperative analgesia without any side effects.

Dose Addition of Tramadol to Levobupivacaine Femoral Nerve Block Prolong Its Analgesic Efficacy in Patients Undergoing Anterior Cruciate Ligament Reconstruction?

Dose Addition of Tramadol to Levobupivacaine Femoral Nerve Block Prolong Its Analgesic Efficacy in Patients Undergoing Anterior Cruciate Ligament Reconstruction?

Efficacy of continuous incision analgesia with 0.2 ％ levobupivacaine for postoperative analgesia in parturients undergoing cesarean section

Objective To evaluate the efficacy of continuous incision analgesia with 0.2％ levobupivacaine for postoperative analgesia in parturients undergoing cesarean section.Methods Thirty ASA physical status Ⅰ or Ⅱ parturients who were at full term,aged 20-30 yr,weighing 60-80 kg,undergoing elective cesarean section,were enrolled in the study.The parturients received 0.2％ levobupivacaine 2 ml/h via a continuous incision analgesia device at the end of surgery.Pain was evaluated by visual analogue scale (VAS).Additional tramadol 50 mg was given when VAS score was above 3 and the consumption was recorded.The effective analgesia within 48 h after surgery (no addition of tramadol,VAS score ≤3) was recorded.The serum prolactin level was measured at 30 min before cesarean section and 24 and 48 h after cesarean section.The colostrum time was recorded.The toxic reaction and side effects were recorded.Results The effective analgesia rate was 80 ％.The consumption of tramadol was (95 ± 15) mg.The colostrum time was (24 ± 6) h.No toxic reaction was found.The serum prolactin level was significantly higher at 24 and 48 h after surgery than that at 30 min before surgery (P ＜ 0.05).Conclusion Continuous incision analgesia with 0.2％ levobupivacaine provides better efficacy,earlier colostrum time and fewer side effects for postoperative analgesia in parturients undergoing cesarean section. Key words: Anesthesia,local; Cesarean section; Analgesia; Pain, postoperative

Evaluation of the addition of tramadol on lidocaine-induced motor block regression time: Experimental study in rats

Evaluation of the addition of tramadol on lidocaine-induced motor block regression time: Experimental study in rats

A Comparison of Levobupivacaine and Levobupivacaine-Tramadol Combination in Bilateral Infraorbital Nerve Block for Postoperative Analgesia After Nasal Surgery

Our aim in this study was to investigate the effect of levobupivacaine and a levobupivacaine + tramadol combination on postoperative analgesia in intraoperative nerve block under standard general anesthetic. Forty-five patients undergoing outpatient nasal surgery under general anesthesia were randomized into 3 groups. Group L: 0.25% levobupivacaine, group T: 0.25% levobupivacaine and 50 mg tramadol, group S: normal saline solution; 2 mL of each being injected into the infraorbital foramen. Intraoperative hemodynamic changes were recorded. Verbal numeric rating scale (NRS) values were checked at 30 minutes and 1, 2, 8, and 12 hours postoperatively, and the need for rescue analgesic treatment in the first 12 hours of all patients was recorded. Also antiemetic drug requirement and side effects (nausea, edema, erythema, hematoma, and sedation) were recorded. At 30 minutes and 1 hour postoperatively, NRS pain scores were lower in group T than in group S (P < 0.0001, P = 0.01, respectively). NRS pain score was lower in group T compared with group L at 1 hour postoperatively (P = 0.01). Effective analgesia time (sec) in the control group (142.67 ± 77.31) was shorter than levobupivacaine (240 ± 96.39) and levobupivacaine added to tramadol groups (277 ± 11.60) (P < 0.05). Additional analgesic requirement in the control group was higher than the other 2 groups in early postoperative period (P < 0.05). Bilateral infraorbital nerve block with 0.25% levobupivacaine is an effective, reliable, and simple technique in the treatment of postoperative pain in nasal surgery. In addition, the addition of tramadol as an adjuvant to local anesthetics in this technique is safe.

Effects of tramadol with tiletamine/zolazepam-xylazine as anaesthesia in cats

This study was conducted to investigate the effect of the combination of tiletamine/zolazepam-xylazine-tramadol (TZXT) in cats and to compare its efficacy as an anaesthetic technique with tiletamine/zolazepam-xylazine (TZX). Fourteen healthy thirteen-month-old cats of both sexes were immobilized by TZXT or TZX on two different occasions. The cats’ scores for immobilization, analgesia and baseline physiological indicators, heart rate, respiratory rate and rectal temperature, were recorded before and 5, 10, 15, 20, 30, 40, 50, 60, 80, 100 and 120 min after administration of TZXT or TZX. Animals in both groups became laterally recumbent within 3 min and physiological indicators changed after administration. These changes were within biologically acceptable limits; these measurements did not differ between the treatments. Induction and recovery quality in animals was better with TZXT than with TZX. Sedation, analgesia, muscle relaxation and posture scores was higher in TZXT group. During recovery, cats in TZXT group were more conscious than cats in TZX group. This study showed that in cats, addition of tramadol (T) to TZX improved the quality of anaesthetic induction and increased the analgesic effect without adversely affecting the physiological indicators. Thus tiletamine/zolazepam-xylazine-tramadol shows to be more suitable for cat anaesthesia.

Comparison of Local Anesthetic Mixtures with Tramadol or Fentanyl for Axillary Plexus Block in Orthopaedic Upper Extremity Surgery

The local anesthetic mixtures are performed for peripheral nerve blocks to accelerate the onset time of sensorial and motor blocks. Also adjuvant agents can be added to local anesthetics to improve the quality and duration of plexus blocks. In this study, we compared the effect of tramadol and fentanyl as adjuvant agents to local anesthetic mixtures in axillary plexus block for orthopedic upper extremity surgery. After approval of hospital ethics committee and written patient consent, sixty patients were enrolled to the study in three groups; The Control Group (Group C, 40 mL of 0.25% levobupivacaine + 40 mg lidocaine n:20), the Fentanyl Group(Group F, 40 mL of 0.25% levobupivacaine + 40 mg lidocaine + 50 mcg fentanyl n:20), the Tramadol Group (Group T, 40 mL of 0.25% levobupivacaine + 40 mg lidocaine + 100 mg tramadol n:20) for axillary plexus block. Groups were compared for partial and complete motor and sensorial block, onset time, partial and complete motor and sensorial block recover time, and postoperative first analgesic requirement time (VAS >4). In Group T partial sensorial block onset time was shorter than Group C and complete sensorial block onset time was shorter than Group C and Group F. In Group T complete sensorial block recover time was longer than Group C and Group F. The postoperative first analgesic requirement time was significantly longer in Group T and F when compared with Group C and significantly longer in Group T when compared with Group F. We conclude that the addition of tramadol or fentanyl to local anesthetic mixtures as an adjuvant agent for axillary block provide better postoperative analgesia for orthopedic upper extremity surgery. Furthermore tramadol more improves the block quality than fentanyl.

Determination of curdione in rabbit plasma by liquid chromatography mass spectrometry

A sensitive and selective liquid chromatography mass spectrometry method for determination of curdione in rabbit plasma was developed. After addition of tramadol as internal standard (IS), protein precipitation by acetonitrile was used for sample preparation. Chromatographic separation was achieved on a Zorbax SB-C₁₈ (2.1 × 50 mm, 3.5 µm) column with acetonitrile-0.1% formic acid as mobile phase with gradient elution. An electrospray ionization source was applied and operated in positive-ion mode; selective ion monitoring was used for quantification using target fragment ions m/z 237 for curdione and m/z 264 for the IS. Calibration plots were linear over the range of 20-4000 ng/mL for curdione in plasma. The lower limit of quantification for curdione was 20 ng/mL. Mean recovery of curdione from plasma was in the range 94.3-98.4%. The RSD of intra-day and inter-day precision were both less than 9%. This method is simple and sensitive enough to be used in pharmacokinetic research for the determination of curdione in rabbit plasma.

The addition of tramadol to morphine via patient-controlled analgesia does not lead to better post-operative pain relief after total knee arthro-plasty

The addition of tramadol to morphine via patient-controlled analgesia does not lead to better post-operative pain relief after total knee arthro-plasty

Single dose caudal tramadol with bupivacaine and bupivacaine alone in pediartic inguinoscrotal surgeries.

To determine the postoperative analgesic effect of Tramadol when given with caudally administered Bupivacaine in children undergoing inguinoscrotal surgeries. Quasi-experimental study. Department of Anaesthesia, Dow University of Health Sciences and Civil Hospital Karachi, from July 2005 to March 2006. A total of 60 children, undergoing inguinoscrotal surgeries, aged from 1 to 12 years, ASA 1 and 2, were included. The patients were divided into two equal groups. The group given Bupivacaine with Tramadol was called 'group BT' and the group which was given only Bupivacaine was labeled as 'group B'. Group BT was given 0.25%,0.8 ml/kg Bupivacaine and Tramadol 2 mg/kg while the other group B was given 0.25%, 0.8 ml/kg Bupivacaine through caudal route after induction of general anesthesia. No other analgesic was given intraoperatively. The postoperative pain was evaluated by using visual analogue scale/Ocher's face scale/CHEOPS and sedation was assessed by 5 points sedation score at immediate postoperative period 1, 2,3,4,6, 12 and 24 hours. Supplemental analgesia in the form of paracetamol suppositories and syrup Ibuprofen was given accordingly. SaO2, pulse, blood pressure, and motor block were monitored in all the patients. Addition of Tramadol with Bupivacaine resulted in meaningfully increased postoperative analgesic period (16.06 +/- 4.04 hours). No other side effects like respiratory depression, pruritus, urinary retention were found in both the groups except for nausea and vomiting. The demand for supplemental analgesia was more in the patients belonging to B group than BT group. The sedation scores were similar in both the groups. The use of Tramadol as an additive with local anesthetics can prolong the postoperative analgesic period when administered caudally. Its use is safe in children.

Comparison of caudal ketamine with lidocaine or tramadol administration for postoperative analgesia of hypospadias surgery in children

This study was designed to investigate whether the addition of tramadol or lidocaine to ketamine would enhance the quality of intra- and postoperative analgesia for hypospadias surgery in children. Sixty-two ASA PS I or II children, between 1 and 10 years of age, scheduled for hypospadias surgery were recruited. Anesthesia was induced with 6-8% sevoflurane and maintained with 0.5-2.5% sevoflurane-50% N2O in oxygen. Children were allocated randomly to receive one of two study drugs. Children in group KL received caudal ketamine (0.25 mg.kg(-1)) plus lidocaine (2%, 2 mg.kg(-1)) and in group KT ketamine (0.25 mg.kg(-1)) plus tramadol (1 mg.kg(-1)). Systemic blood pressure, heart rate, peripheral O2 saturation, sedation, and pain scores (CHEOPS) were recorded at 1, 5, 10, 15, 30, 45 min and 1, 2, 3 h following recovery from anesthesia. Duration of analgesia was similar in the two groups (P > 0.05). CHEOPS in group KL was lower than in group KT during the study period, except at first 15 min. Sedation scores were higher in group KL than group KT in the first 10 min (P < 0.05). Incidence of postoperative nausea and vomiting was similar in the two groups (P > 0.05) Sevoflurane concentration required was significantly lower in group KL than group KT peroperatively (P < 0.001). Caudal ketamine (0.25 mg.kg(-1)), plus lidocaine (2% 2 mg.kg(-1)) significantly reduced sevoflurane concentration compared with ketamine (0.25 mg.kg(-1)) + tramadol (1 mg.kg(-1)). We suggested that both ketamine + lidocaine and ketamine + tramadol provided very effective and long duration of analgesia, similarly. However, analgesia quality is superior in the ketamine-lidocaine group postoperatively.

The Addition of Tramadol to Lidocaine Does Not Reduce Tourniquet and Postoperative Pain During IV Regional Anesthesia

The Addition of Tramadol to Lidocaine Does Not Reduce Tourniquet and Postoperative Pain During IV Regional Anesthesia

Postoperative Pain Management After Supratentorial Craniotomy

The aim of this study was to compare the analgesic efficacy of three different postoperative treatments after supratentorial craniotomy. Sixty-four patients were allocated prospectively and randomly into three groups: paracetamol (the P group, n = 8), paracetamol and tramadol (the PT group, n = 29), and paracetamol and nalbuphine (the PN group, n = 27). General anesthesia was standardized with propofol and remifentanil using atracurium as the muscle relaxant. One hour before the end of surgery, all patients received 30 mg/kg propacetamol intravenously then 30 mg/kg every 6 hours. Patients in the PT group received 1.5 mg/kg tramadol 1 hour before the end of surgery. For patients in the PN group, 0.15 mg/kg nalbuphine was injected after discontinuation of remifentanil, because of its mu-antagonist effect. Postoperative pain was assessed in the fully awake patient after extubation (hour 0) and at 1, 2, 4, 8, and 24 hours using a visual analog scale (VAS). Additional tramadol (1.5 mg/kg) or 0.15 mg/kg nalbuphine was administered when the VAS score was > or = 30 mm. Analgesia was compared using the Mantha and Kaplan-Meier methods. Adverse effects of the drugs were also measured. The three groups were similar with respect to the total dose of remifentanil received (0.27 +/- 0.1 mircog/kg/min). In all patients, extubation was obtained within 6 +/- 3 minutes after remifentanil administration. Postoperative analgesia was ineffective in the P group; therefore, inclusions in this group were stopped after the eighth patient. Postoperative analgesia was effective in the two remaining groups because VAS scores were similar, except at hour 1, when nalbuphine was more effective (P = .001). Nevertheless, acquiring such a result demanded significantly more tramadol than nalbuphine (P < .05). More cases of nausea and vomiting were observed in the PT group but the difference was not significant (P < .06). In conclusion, pain after supratentorial neurosurgery must be taken into account, and paracetamol alone is insufficient in bringing relief to the patient. Addition of either tramadol or nalbuphine to paracetamol seems necessary to achieve adequate analgesia, with, nevertheless, a larger dose of tramadol to fulfill this objective.