Dose Of Tramadol Research Articles

Observation on the Efficacy of Preemptive Analgesia with Tramadol Injection after Single-Segment Lumbar Spinal Stenosis Surgery

To investigate the efficacy of preemptive analgesia with tramadol injection after single-segment lumbar spinal stenosis surgery is the objective of the study. A total of 120 patients after lumbar spinal stenosis surgery were selected by the random sampling method as the study subjects. Patients were randomly divided into a moderate pain group (control group, n=60) and a preemptive analgesia group (observation group, n=60) according to whether tramadol preemptive analgesia was used. The visual analogue scale score of the two groups were compared at 30 min, 4 h, 8 h, 16 h, 24 h and 48 h after treatment, the number of intramuscular tramadol injections and the total dosage of tramadol administration from the end of surgery to discharge, as well as adverse reactions after treatment. The visual analogue scale score at 30 min, 4 h, 8 h, 16 h and 24 h after surgery of the observation group were significantly lower than the control group (p<0.05). There was no significant difference between the two groups in the visual analogue scale score at 48 h after surgery (p>0.05).The number of intramuscular tramadol injections and the total dosage of tramadol administration from the end of surgery to discharge of the observation group were significantly lower than the control group (p<0.05). The incidence of adverse reactions in the observation group was lower than the control group, but the difference was not statistically significant (p>0.05). Tramadol preemptive analgesia after lumbar spinal stenosis surgery could effectively control pain, reduce the use frequency of postoperative painkillers, reduce the dosage of intramuscular tramadol after surgery and had fewer adverse reactions in the process of treatment to some extent.

The acute effects of different doses of tramadol on neuronal activity of medial prefrontal cortex in rats

Background:Tramadol is an opioid analgesic with monoamine reuptake inhibitory effects. Although tramadol has been widely used to control pain, there is controversy about the risk of abuse. Therefore, in the present study, the acute effects of tramadol on neuronal activity in the medial prefrontal cortex (mPFC), which is one of the important centers of the reward system, were investigated electrophysiologically.Materials and Methods:Tramadol was injected interperitoneally (12.5 and 25 mk/kg) or subcutaneously (40 mg/kg) and its effect on the firing of mPFC neurons was investigated, using in vivo extracellular single unit recording.Results:Tramadol could not significantly affect neural activity in mPFC, suggesting no acute and rapid effect on mPFC.Conclusions:The present results showed that neural activity in mPFC was not rapidly affected by acute application of tramadol. Since the role of mPFC in tramadol addiction has been elucidated, it can be concluded that these effects may be due to delayed responses or chronic use of tramadol.

Preemptive analgesic effect of ultrasonography-guided transversus abdominis plane block performed by adding dexamethasone to bupivacaine

The objective of this study was to evaluate the preemptive analgesic effect of ultrasound-guided transversus abdominis plane block performed with bupivacaine or adding dexamethasone on bupivacaine in laparoscopic cholecystectomy. This retrospective study was conducted on a total of 84 patients who underwent ultrasound-guided TAP block in laparoscopic cholecystectomy. Patients were divided into two groups: Group Bupivacaine (Group B) and Group Bupivacaine+Dexamethasone (Group B+D). Intraoperative hemodynamic changes, intraoperative remifentanil consumption, postoperative visual analog scale scores, tramadol consumption in 24 hours postoperatively, and postoperative first analgesic time were obtained from the records and compared between the groups. There were no statistically significant differences between both groups in terms of intraoperative heart rate, mean arterial pressure, oxygen saturation, and end-tidal CO2 values. Postoperative visual analog scale scores, doses of remifentanil and total tramadol, and time of receiving the first analgesic were similar. Dexamethasone can be added to the bupivacaine for the TAP block without major side effects. Adding dexamethasone to bupivacaine in transverse abdominis plane block performed in laparoscopic cholecystectomy procedures did not create a significant difference in VAS score. We think that the use of dexamethasone does not have an additional analgesic effect. However, our results should be supported by further studies.

Pharmacological evidence for the possible involvement of the NMDA receptor pathway in the anticonvulsant effect of tramadol in mice.

Previous studies have shown controversial results regarding the pro- or anticonvulsant effects of tramadol. Additionally, the underlying mechanism of seizure induction or alleviation by tramadol has not been fully understood. In the current study, the effects of tramadol on pentylenetetrazole (PTZ)-induced seizure and the possible involvement of the N-methyl-D-aspartate (NMDA) pathway were assessed in mice. Male Naval Medical Research Institute (NMRI) mice were treated with intravenous infusion of PTZ in order to induce clonic seizures and determine seizure threshold. Tramadol was injected intraperitoneally (0.1-150 mg/kg) 30 minutes prior to elicitation of seizures. The possible effects of intraperitoneal injections of NMDA receptor antagonists, ketamine (0.5 mg/kg) and MK-801 (0.5 mg/kg) on the anticonvulsant property of tramadol were investigated subsequently. Tramadol (1-100 mg/kg) increased PTZ-induced seizure threshold in a dose-dependent, time-independent manner, with optimal anticonvulsant effect at a dose of 100 mg/kg. Acute administration of either ketamine (0.5 mg/kg) or MK-801 (0.5 mg/kg) potentiated the anticonvulsant effect of a subeffective dose of tramadol (0.3 mg/kg). These results suggest a possible role of the NMDA pathway in the anticonvulsant effect of tramadol.

Synergistic analgesic effect of morphine and tramadol in non‑sensitized and morphine‑sensitized mice: an isobolographic study

Morphine and tramadol are the opioid analgesic drugs acting via activation of μ‑opioid receptors. It is important to understand which mechanism (synergistic or additive anti‑nociceptive activity) induced potent anti‑nociceptive effect by co‑administration of morphine and tramadol. Identification of new strategies that can potentiate analgesic effects of opioids will be good therapeutic approaches for pain relief. To this aim, male mice were cannulated in the left ventricle by a stereotaxic instrument. A tail‑flick test was used to record the pain threshold. The results revealed that intracerebroventricularly injection of morphine induced an anti‑nociceptive effect in non‑sensitized and morphine‑sensitized mice. We found that infusion of tramadol produced an anti‑nociceptive response in non‑sensitized mice, whereas tramadol in doses of 0.5 and 1 μg/mouse induced analgesia in morphine‑sensitized mice. Co‑injection of a non‑effective dose of tramadol or morphine (0.25 μg/mouse) with different doses of morphine or tramadol (0.25, 0.5, and 1 μg/mouse) respectively potentiated the analgesic effect of the previous drug. An isobolographic analysis of data was performed, indicating a synergistic interaction between morphine and tramadol in non‑sensitized and morphine‑sensitized mice. Our data indicated that both morphine and tramadol elicit more anti‑nociceptive response in morphine sensitized mice; there is a synergistic effect between morphine and tramadol upon induction of analgesic effect in non‑sensitized and morphine‑sensitized mice.

Brain Tissues Affection After Oral Tramadol: An Experiment Study

Tramadol may lead to the accumulation of toxic components in the body. This study aims to detect the toxic effect of tramadol on brain tissues. The clinical experiment was carried out at the Department of Neurosurgery, Ibn Sina Hospital. Ten rats of both sex weighing (180-300 g) were selected from the veterinary house. Brain tissues were immediately removed and put into 10% neutral buffer formalin for fixation, then stained with Hematoxylin-Eosin stain. A significant decrease in the brain weight in rats when given the tramadol in dose 50 mg/ kg. Changes included a mild degree of tissue injury in the cerebral cortex, increase in vacuolar degeneration, with atrophy and degeneration of neurons. There are toxic effects when tramadol describes for a long time on the brain tissues.

Opioid Overdose and Serotonin Syndrome due to Gastric Bezoar in a Woman with Autism and Pica Behaviour

We are presenting the case of a 38-year-old woman with nonverbal autism and intellectual disability, hospitalized in a neurobehavioural unit because of a pica behaviour for 3 years. During the hospitalization, the patient presented an episode of pain, agitation, restlessness, rhabdomyolysis, coma, tachycardia, hyperthermia, shivering, and diarrhoea. The main hypothesis raised was tramadol overdose because of the immediate antidote response to the injection of naloxone 0,4 mg/mL. Even if we did not exceed the recommended prescription dosage of tramadol, the presence of gastric bezoar slowed the absorption of the drug, and the consequence was an opioid overdose and serotonin syndrome.

Effect of Tramadol on Hormones and Lipid Peroxidation of male Rabbits

Tramadol manhandle straightforwardly impacts the discharge of luteinizing hormone and follicular stimulating g hormone from the front pituitary organ that diminishes the common discharge of luteinizing hormone in a pulsatile way, resulting in a negative impact on male testiclesdue to lower levels of testosterone hormone. Animals were orally given 40 mg/kg B.W. doses of tramadol. The tried measurements were given to rabbits each other day for 6 weeks. Tramadol significantly decreased body weight (BW), weight of brain, testes, testosterone, estradiol, follicle stimulating hormone (FSH), luteinizing hormone (LH), triiodothyronine (T3) and thyroxin hormone (T4). While, it caused significant increase in thiobarbituric acid-reactive substances (TBARS) concentrations in plasma, testes and brain. Keywords: Tramadol; Hormone; TBARS; Rabbits

Stevens-Johnson syndrome linked to tramadol use and ultraviolet radiation

Abstract Rationale: Stevens-Johnson syndrome (SJS) is a cutaneous reaction characterized by necrosis and epidermal detachment, commonly triggered by medications. Tramadol rarely causes SJS, and ultraviolet radiation (UVR) has limited recognition as being linked to SJS presentations. Patient concerns: A previously healthy 18-year-old female presented to the emergency department with what she believed to be a severe sunburn. Five days prior, she was exposed to extensive sun exposure while swimming all day at a lake. The following day, she developed a rash on her shoulders, which became widespread, extending to the palms of her hands and soles of her feet, and eventually involved her oral and ocular mucosa. At the time of hospital admission, the rash had progressed to form vesicles/bullae with skin sloughing and a positive Nikolsky sign, bleeding ulcers throughout the oral mucosa, and bilateral conjunctival hyperemia with purulent discharge. Diagnosis: The patient reported no medication use apart from a single dose of tramadol 7 to 10 days prior to rash onset. Given the clinical presentation and histopathological findings that were consistent with SJS, a diagnosis of SJS was made. The nature of this patient's rash onset, character, and progression suggests that UVR precipitated the event in conjunction with tramadol as the causative agent. Interventions: The patient received fluid resuscitation and was transferred via air ambulance to a trauma and burn center to receive treatment. Outcomes: Complete resolution of the patient's cutaneous and oral mucosal lesions occurred 4 weeks after discharge; however, hypopigmentation was evident in areas where cutaneous re-epithelialization had occurred. The patient was advised to strictly avoid the use of tramadol and limit her exposure to UVR. Lesson: Physicians should be aware that tramadol may cause SJS and that UVR may precipitate SJS in patients taking tramadol. Rapid diagnosis of SJS and transfer to a trauma or burn center improves patient outcomes.

Gonadotoxic effect of tramadol administration: A prospective controlled study

ABSTRACT Objective To detect the possible gonadotoxic effects of tramadol dependence on seminal fluid parameters, and prolactin and testosterone hormone levels. Patients, Subjects, and Methods There were 94 participants who were divided into a tramadol-dependent group (T-group; 56 patients) and a control group (C-group; 38 healthy volunteers). The following variables were evaluated: testosterone level, prolactin level, erectile function, libido, semen parameters, and effect of tramadol dose and dependence duration. Results There was a significant increase in erectile dysfunction (ED) and decreased libido in the T-group vs C-group. Also, the serum testosterone level was lower in the T-group vs the C-group, while the serum prolactin level was significantly higher in the T-group vs the C-group. All semen parameters were low in the T-group except for abnormal forms, which were high. As the dose of tramadol increased there was a more negative effect on the previous parameter, while ED, libido, semen volume and concentration showed no significant changes. When comparing tramadol doses of 400–1000 mg/day to >1000 mg/day, the tramadol blood level increased with high doses, while serum testosterone level decreased when the dose increased and the prolactin level increased when the dose increased. Progressive motility of the sperm decreased and abnormal forms increased. Also increased duration of tramadol administration was also accompanied by a more negative effect on these parameters Conclusion Tramadol administration has a negative effect on hormone levels, libido, erectile function, and semen characters.Abbreviations:ED: erectile dysfunction; EF: erectile function

Identification for antitumor effects of tramadol in a xenograft mouse model using orthotopic breast cancer cells

In our previous research showed that tramadol having potential anti-tumor effect was associated with enhancement of oncological prognosis in patients with breast cancer surgery. As these effects have not been confirmed by clinical dose-regulated animal or prospective human studies, we investigated the anti-tumor effect of tramadol in vivo. Female nude mice orthotopically inoculated with luciferase-expressing MCF-7 cells, were randomly divided into the control (saline), tramadol group 1 (1.5 mg kg−1 day−1), tramadol group 2 (3 mg kg−1 day−1), and morphine (0.5 mg kg−1 day−1) (n = 5/group). Bioluminescence signals after D-luciferin injection, tumor size, and tumor weight were compared among groups after 4 weeks. Estrogen receptor (ER), progesterone receptor (PR), and transient receptor potential vanilloid (TRPV)-1 expression, natural killer (NK) cell activity, and serum interleukin (IL)-1β, tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and interleukin (IL)-6 were then examined. Tumour growth was attenuated in tramadol-treated groups (P < 0.05). NK cell activity was significantly decreased only in the morphine treated group not in sham, control, and tramadol groups. The expression levels of ERα, PRα and β, and TRPV1 were decreased in tramadol group 2 compared with those in the morphine group, but not compared to the control group. Serum levels of IL-6 and TNFα were reduced in both tramadol-treated group 1 and 2 compared to the control group. Overall, clinical dose of tramadol has anti-tumour effects on MCF-7 cell-derived breast cancer in a xenograft mouse model.

Subanesthetic intravenous ketamine vs. caudal bupivacaine for postoperative analgesia in children undergoing infra-umbilical surgeries: a non-inferiority randomized, single-blind controlled trial.

BackgroundSubanesthetic intravenous (IV) ketamine acts as an analgesic and has opioid-sparing effects, particularly for acute postoperative pain; however, its effectiveness in children is understudied. The primary aim of this study was to evaluate the non-inferiority of subanesthetic IV ketamine vs. caudal bupivacaine for postoperative analgesia in children undergoing infra-umbilical surgery.MethodsChildren aged < 6 years were enrolled in this single-blind study and randomized to receive either subanesthetic IV ketamine (0.3 mg/kg) or caudal 0.125% bupivacaine (1 ml/kg) along with general anesthesia. Postoperative pain was assessed using the FLACC scale at 30 minutes and 1, 2, 3, and 6 h post-operation. Intra- and postoperative opioid consumption, time to extubation, postoperative vomiting, agitation, sedation, and inflammatory markers were also assessed.ResultsAltogether, 141 children completed the study (ketamine group: n = 71, caudal group: n = 70) The cumulative proportion of children without significant postoperative pain (FLACC score < 4) in the first 6 h post-surgery was 45.1% in the ketamine group vs. 72.9% in the caudal group (P < 0.001). More children in the ketamine group required an additional dose of intraoperative fentanyl (33.8% vs. 5.7%, P < 0.001) and postoperative tramadol (54.9% vs. 27.1%, P < 0.001). However, postoperative agitation, sedation, and other secondary outcomes were similar between the groups.ConclusionsSubanesthetic ketamine is inferior to caudal bupivacaine for postoperative analgesia in children aged < 6 years undergoing infra-umbilical surgeries; however, other postoperative outcomes are similar.

Involvement of the Peripheral μ-Opioid Receptor in Tramadol-Induced Constipation in Rodents.

Tramadol is a weak opioid that produces analgesic effect via both the μ-opioid receptor (MOR) and non-opioid targets. Constipation is the most common opioid-related side effect in patients with cancer and non-cancer pain. However, the contribution of MOR to tramadol-induced constipation is unclear. Therefore, we used naldemedine, a peripherally acting MOR antagonist, and MOR-knockout mice to investigate the involvement of peripheral MOR in tramadol-induced constipation using a small intestinal transit model. A single dose of tramadol (3-100 mg/kg, per os (p.o.)) inhibited small intestinal transit dose-dependently in rats. Naldemedine (0.01-10 mg/kg, p.o.) blocked the inhibition of small intestinal transit induced by tramadol (30 mg/kg, p.o.) in rats. The transition rate increased dose-dependently over the range of naldemedine 0.01-0.3 mg/kg, and complete recovery was observed at 0.3-10 m/kg. Additionally, tramadol (30 and 100 mg/kg, subcutaneously (s.c.)) inhibited small intestinal transit in wild-type mice but not in MOR-knockout mice. These results suggest that peripheral MOR participates in tramadol-induced constipation.

Effectiveness of Tramadol in Controlling Postanesthetic Shivering

Objectives: The objective of the study was to assess the effectiveness of intravenous tramadol in controlling post anesthetic shivering and to assess which of the dose of drug is safe and effective. Material and Methods: In this study we included 120 patients age &gt;18 years of ASA class I &amp; II who underwent any surgical procedure under spinal/general anesthesia. Patients were divided into 3 groups of equal size of 40 subjects. Group A; in these patients tramadol 0.25 mg/kg I/V was given for shivering management. Group B; in these patients Tramadol 0.5 mg/kg I/V was given and Group C (control group); in these patients normal saline 0.05 ml/kg I/V was given. The adequate control of shivering was the main study objective. Side effects of tramadol at different doses were also observed. Results: At five minutes, Grade 0,1 and 2 shivering were observed in 23 patients in group A and 31 patients in group B while in group C grade 3 and 4 shivering were observed. High grade (3 and 4) shivering were significantly high in group C than group A and B (p-value= 0.005). Similarly, at 10 minutes, grade 3 and 4 shivering were significantly high in group C than group A and B (p-value 0.005). Conclusion: IV 0.25 mg/Kg is an effective option for control of post-anesthesia shivering with minimal side effect profile. So low dose tramadol can be used as a first option for post-anesthesia shivering control. Keywords: Anesthesia, Shivering, Tramadol.

Prevalence, correlates, and consequences of attention-deficit/hyperactivity disorder in a clinical sample of adults with tramadol use in Egypt.

Many studies investigated the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) but none focused on the association between ADHD and nonmedical prescription opioids such as tramadol. The objective of this study was to assess the prevalence, correlates, and consequences of co-occurrence of ADHD and tramadol use among adults. This study included 122 Egyptian adults with opioid use disorders attributed to tramadol (N = 122). Participants were recruited from the psychiatric outpatient clinic and inpatient unit of Zagazig University Hospital, Egypt. ADHD and SUDs were assessed by using the Adult ADHD Self-Report Scale (ASRS-v 1.1) and SCID-I criteria of DSM-5, respectively. All participants were screened for drugs by urinalysis. Forty percent of the participants used tramadol alone, whereas the remaining used it with other substances, such as alcohol (51.6%) and cannabis (48.4%). Thirty-eight cases (31%) had adult ADHD and most of them had inattentive or mixed types. Adults with tramadol use and ADHD were more likely to have a younger age of onset of tramadol use, use a higher dose of tramadol, and use it for a longer duration than those with tramadol use without ADHD. ADHD in adults with tramadol use is common and is associated with early-onset, high dose, and long duration of tramadol use. This is the first study to investigate the co-occurrence of ADHD and tramadol misuse among adults.

Plasma concentrations of tramadol after transdermal application of a single metered dose of a compounded tramadol gel to cats.

To determine plasma tramadol concentrations in cats following a single dose of oral and transdermal formulations and the pharmacokinetics for and the concentration of tramadol in the transdermal formulation. 8 healthy client-owned domestic shorthair cats. 1 cat was orally administered 1 dose of tramadol (2 mg/kg), and 7 cats received 1 dose of a proprietary compounded tramadol gel product (median actual dose, 2.8 mg/kg) applied to their inner pinnae. Plasma tramadol concentrations were measured with high-performance liquid chromatography-mass spectrometry at fixed times over 24 hours. Plasma tramadol concentrations were undetectable or much lower (range, < 1 to 4.3 ng/mL) following application of the transdermal formulation, compared with those following oral administration (maximum plasma tramadol concentration, 261.3 ng/mL [at 4 hours]). Tramadol pharmacokinetics for the transdermal formulation could not be determined. Tramadol concentrations of the transdermal gel product exceeded the estimated label dose in all analyzed gel samples, with concentrations greater than the 90% to 110% United States Pharmacopeia standard for compounded drugs. Application of 1 dose of the proprietary transdermal formulation did not yield clinically relevant plasma tramadol concentrations in cats. Although this proprietary formulation is currently available to prescribing veterinarians, it should be used with caution.

Physiologically Based Pharmacokinetic Modeling to Assess the Impact of CYP2D6-Mediated Drug-Drug Interactions on Tramadol and O-Desmethyltramadol Exposures via Allosteric and Competitive Inhibition.

Tramadol is an opioid medication used to treat moderately severe pain. Cytochrome P450 (CYP) 2D6 inhibition could be important for tramadol, as it decreases the formation of its pharmacologically active metabolite, O‐desmethyltramadol, potentially resulting in increased opioid use and misuse. The objective of this study was to evaluate the impact of allosteric and competitive CYP2D6 inhibition on tramadol and O‐desmethyltramadol pharmacokinetics using quinidine and metoprolol as prototypical perpetrator drugs. A physiologically based pharmacokinetic model for tramadol and O‐desmethyltramadol was developed and verified in PK‐Sim version 8 and linked to respective models of quinidine and metoprolol to evaluate the impact of allosteric and competitive CYP2D6 inhibition on tramadol and O‐desmethyltramadol exposure. Our results show that there is a differentiated impact of CYP2D6 inhibitors on tramadol and O‐desmethyltramadol based on their mechanisms of inhibition. Following allosteric inhibition by a single dose of quinidine, the exposure of both tramadol (51% increase) and O‐desmethyltramadol (52% decrease) was predicted to be significantly altered after concomitant administration of a single dose of tramadol. Following multiple‐dose administration of tramadol and a single‐dose or multiple‐dose administration of quinidine, the inhibitory effect of quinidine was predicted to be long (≈42 hours) and to alter exposure of tramadol and O‐desmethyltramadol by up to 60%, suggesting that coadministration of quinidine and tramadol should be avoided clinically. In comparison, there is no predicted significant impact of metoprolol on tramadol and O‐desmethyltramadol exposure. In fact, tramadol is predicted to act as a CYP2D6 perpetrator and increase metoprolol exposure, which may necessitate the need for dose separation.

Effects of naloxone and diazepam on blood glucose levels in tramadol overdose using generalized estimating equation (GEE) model; (an experimental study)

BackgroundTramadol is a synthetic opioid and poisoning is increasing around the world day by day. Various treatments are applied for tramadol poisoning. Due to the unknown effects of tramadol poisoning and some of its treatments on blood glucose levels, this study was conducted to investigate the overdose of tramadol and its common treatments (naloxone, diazepam), and their combination on blood glucose levels in male rats.MethodsThis study was conducted in 45 male Wistar rats. The animals were randomly divided into five groups of 9. They received a 75 mg/kg dose of tramadol alone with naloxone, diazepam, and a combination of both of these two drugs. On the last day, animals’ tail vein blood glucose levels (BGL) were measured using a glucometer at different times, including before the tramadol injection (baseline) and 1 hour, 3 hours, and 6 hours after wards. The rats were anesthetized and sacrificed 24 h after the last injection. Blood samples were then taken, and the serum obtained was used to verify the fasting glucose concentration. Data were analyzed using SPSS software at a significance level of 0.05 using a one-way analysis of variance (ANOVA) and a generalized estimating equation (GEE).ResultsAccording to the GEE model results, the diazepam-tramadol and naloxone-diazepam-tramadol groups showed blood glucose levels five units higher than the tramadol group (p < 0.05). The diazepam-tramadol group had significantly higher blood glucose levels than the naloxone-tramadol group (p < 0.05). The mean blood glucose levels before the intervention, 3 hours and 6 hours after the injection of tramadol did not differ between the groups, but the blood glucose levels 1 hour after the injection of tramadol in the group of naloxone-tramadol were significantly lower than in the control group (p < 0.05). Blood glucose levels did not differ between the groups 24 h after injection of tramadol.ConclusionThe results of the present study showed tramadol overdose does not affect blood glucose levels. The diazepam-tramadol combination and the diazepam-naloxone-tramadol combination caused an increase in blood glucose levels.

Tramadol Poisoning: A Systematic Review of Studies in Iran

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran. Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation. Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for &gt;24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level. Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.

Oral analgesia in fixed-time interval administration versus spinal morphine for post-Cesarean pain: a randomised controlled trial.

PurposeTo compare the efficacy of fixed-time-interval oral analgesia and spinal-morphine for management of post-Cesarean pain.MethodsIn this open-label, parallel-group, randomized, controlled trial, 200 women due to undergo elective Caesarean section with spinal anaesthesia were enrolled between July 2015 and April 2016. Patients were randomly assigned to receive either spinal fentanyl followed by oral doses of tramadol, paracetamol, and diclofenac at predetermined regular intervals of 6 h for the first 48 h, and rescue treatment with percocet (oxycodone and paracetamol; oral analgesia group), or spinal morphine and rescue treatment with oral tramadol, paracetamol, and diclofenac (spinal-morphine group). The primary outcomes were pain intensity during the postoperative 48 h, measured on a 10-point numeric rating scale (NRS) and expressed as area under the curve (AUC), and the number of breakthrough events of moderate to severe pain (defined as NRS score ≥ 4).ResultsThe oral analgesia group compared to the spinal-morphine group had similar mean pain intensity (AUC (120 ± 35 versus 121 ± 31, respectively; p = 0.8) but more events of moderate-to-severe breakthrough pain (4.8 ± 2 versus 3.8 ± 1.7, respectively; p = 0.0002). Higher rates and longer durations of pruritus, nausea, and vomiting were reported among patients receiving spinal morphine, as compared with oral analgesia. Satisfaction scores were high in both groups (8.2 ± 2.4 versus 8.7 ± 1.8 in the oral analgesia and spinal morphine, respectively; p = 0.23).ConclusionsBoth oral analgesia at fixed time intervals and spinal morphine are satisfactory methods for treating post-Caesarean pain.Trial registrationClinicalTrials.gov Identifier: NCT02440399, date of registration: 07/05/ 2015. URL: https://clinicaltrials.gov/ct2/show/NCT02440399?term=enav+yefet&rank=7.