Intramuscular Tramadol Research Articles

Post-Caesarean analgesia in Timor-Leste, a low-middle-income country

Timor-Leste is a small, low-middle-income country in Southeast Asia. It is reported to spend less on healthcare than any other country. Hospital Nacional Guido Valadares performs 6 000 deliveries a year. Epidural analgesia, intrathecal opiates, transversus abdominis plane blocks, oral and intravenous opiates, and non-steroidal anti-inflammatory agents have all been mooted as techniques useful in improving post-caesarean analgesia. Most of these options are unavailable in Timor-Leste. Opiate use in theatre is minimal and opiates are unavailable on the ward. Epidural anaesthesia and patient controlled analgesia are unavailable. A locally formulated post-caesarean pain management protocol, taking into account available agents and expertise, encourages spinal anaesthesia with hyperbaric bupivacaine followed by 100 mg intramuscular tramadol in the recovery area, followed by oral paracetamol 1 gm qid., tramadol 50 mg qid. and ibuprofen 400 mg tds. in the wards. This study sought to determine the efficacy of this protocol in a low resource environment.

Intracutaneous sterile water versus intramuscular tramadol injection in relief of low back pain in labour

Intracutaneous sterile water versus intramuscular tramadol injection in relief of low back pain in labour

ROLE 0F INTRAMUSCULAR TRAMADOL IN LABOUR ANALGESIA.

20Aug 2018 ROLE 0F INTRAMUSCULAR TRAMADOL IN LABOUR ANALGESIA. Tashaffi Qayoom and Sabha Malik. Senior residents , Department of Obstetrics and Gynaecology , SKIMS , Srinagar

Labor analgesia in parturients of fetal growth restriction having raised umbilical Doppler vascular indices.

Background and Aims:Fetuses with abnormal umbilical blood flow are at a higher risk of adverse perinatal outcome than those with normal flow. Epidural analgesia (EA) has shown to decrease villous vascular resistance in preeclamptic women during labor. The present study evaluates the effects of epidural ropivacaine and intramuscular (IM) tramadol on Doppler blood flow in parturients with fetal growth restriction and raised umbilical artery (UmA) blood flow.Material and Methods:In this prospective nonrandomized comparative study, 36 term parturients with sonographic evidence of UmA systolic-diastolic (S-D) ratio ≥3 were enrolled. Parturients received either continuous epidural ropivacaine 0.2% or 1 mg/kg IM tramadol 4–6 hourly. Doppler flow parameters of UmA and bilateral uterine arteries (UtAs) were measured at 0, 1, and 6 h of labor analgesia. Doppler indices change with time during labor analgesia was assessed as the primary outcome. Change of Doppler indices of UtAs, Apgar score, and cord blood gases was considered as secondary measures.Results:Data from thirty laboring women who completed the study were analyzed. The pulsatility index, resistance index, and S-D ratio in UmA and right UtA reduced significantly with continuous epidural infusion during first 6 h of labor. However, these values increased or unchanged with tramadol administration. Better neonatal pH and base deficit (P = 0.039) were observed with EA.Conclusions:Continuous epidural ropivacaine causes improved fetoplacental circulation in parturients with growth-restricted fetuses having raised Doppler indices during labor analgesia. We also found better neonatal outcome with continuous infusion of epidural ropivacaine as compared to IM tramadol.

Methoxyflurane inhalation vapour in trauma pain: a profile of its use in the EU

Methoxyflurane (Penthrox®) administered as an inhalation vapour via a hand-held inhaler is approved in Europe for the emergency relief of moderate to severe pain in conscious adults with trauma-associated pain. The time to the onset of meaningful pain relief is 3–4 min. Methoxyflurane provided effective levels of analgesia in patients presenting to the emergency department pain associated with minor trauma, was more effective than intramuscular tramadol when administered by paramedics for acute musculoskeletal pain, and had a more rapid onset of action than tramadol in patients presenting to the emergency department with ankle injuries. When used to relieve trauma pain in the emergency setting, methoxyflurane is generally well tolerated and, unlike when it was used at higher doses as an inhalational anaesthetic, is not associated with a risk of nephrotoxicity. With its non-invasive route of administration, ease of use and/or rapid onset of action, patient-administered inhaled methoxyflurane is a useful option for the management of trauma pain in the pre-hospital or emergency department setting.

Yamamoto New Scalp Acupuncture for postoperative pain management in cats undergoing ovariohysterectomy

ObjectiveTo evaluate the analgesic efficacy of Yamamoto New Scalp Acupuncture (YNSA) as an adjuvant for postoperative pain management in cats. Study designProspective, randomized, blinded, clinical study. AnimalsTwenty cats aged (mean ± standard deviation) 25 ± 9 months and weighing 2.7 ± 0.6 kg undergoing ovariohysterectomy. MethodsThe cats were sedated with intramuscular (IM) ketamine (5 mg kg−1), midazolam (0.5 mg kg−1) and tramadol (2 mg kg−1). The cats were randomly distributed before induction of anesthesia into two groups of 10 cats each: group YNSA, in which bilateral basic D points were stimulated with a dry needle from 20 minutes prior to anesthetic induction to the end of the surgery; group Control, in which no acupuncture was applied. Postoperative analgesia was assessed at 1, 2, 4, 8, 12, 18 and 24 hours postextubation using an Interactive Visual Analog Scale and Universidade Estadual Paulista-Botucatu Multidimensional Composite Pain Scale (UNESP-Botucatu MCPS). Rescue analgesia was provided with IM tramadol (2 mg kg−1), and the pain scores were reassessed 30 minutes after rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg kg−1 as a single dose) was administered IM. Data were analyzed using Student t-test, Fisher exact test, Mann–Whitney U test and Friedman test (p < 0.05). ResultsSignificantly lower pain scores were observed in YNSA when compared with Control at 1–4 hours based on the UNESP-Botucatu MCPS scores. Although significant differences were not identified between groups requiring rescue analgesia, additional postoperative analgesia was administered to four of 10 cats in Control and no cats in YNSA. Conclusion and clinical relevancePerioperative YNSA resulted in decreased pain scores and a reduction in postoperative requirement for rescue analgesia in cats. This method should be considered a viable option as an adjuvant analgesic therapy for cats undergoing ovariohysterectomy.

Influence of two administration rates of propofol at induction of anaesthesia on its relative potency in cats: a pilot study.

Objectives This was a randomised, blinded trial to investigate the influence of administration rate on the dose of propofol required for the orotracheal intubation of cats. Methods Twenty-four female domestic cats undergoing ovariohysterectomy were premedicated with oral tramadol (6 mg/kg) or intramuscular tramadol (4 mg/kg), and intramuscular dexmedetomidine (0.007 mg/kg). Oral or intramuscular (IM) tramadol was administered 60 or 30 mins prior to induction of anaesthesia, respectively. Dexmedetomidine was administered 30 mins prior to anaesthetic induction. Sedation scores were established prior to anaesthesia induction with propofol intravenously at 4 mg/kg/min (fast) or 1 mg/kg/min (slow) to effect until orotracheal intubation was achieved without coughing. If coughing occurred, the intubation process was paused for 15 s. Four groups were determined: IM tramadol/propofol fast (GIMF, n = 6); IM tramadol/propofol slow (GIMS, n = 6); oral tramadol/propofol fast (GOF, n = 6); oral tramadol/propofol slow (GOS, n = 6). The Shapiro-Wilk test was used to evaluate for normality of residuals. Sedation scores and propofol anaesthetic induction doses were compared between GIMF and GIMS groups, and between GOF and GOS groups using the Mann-Whitney test and the t-test, respectively ( P = 0.05). The presence of hypotension (mean arterial blood pressure <60 mmHg) or apnoea (no breathing for 30 s or more) within the first 15 mins postintubation was recorded. Results The median sedation scores for GIMF and GOF were not significantly different compared with those for GIMS ( P = 0.94) and GOS ( P = 0.70). However, the mean ± SD propofol anaesthetic induction doses were higher in GIMF (9.1 ± 1.8 mg/kg) and GOF (7.9 ± 1.7 mg/kg) than in GIMS (5.1 ± 1.5 mg/kg; P <0.01) and GOS (5.4 ± 0.3 mg/kg; P <0.01). No hypotension or apnoea were detected. Conclusions and relevance Using the slower anaesthetic induction rate resulted in an increase in propofol relative potency.

Pain relief in labor: A randomized controlled trial comparing intramuscular tramadol with intramuscular paracetamol at the University College Hospital, Ibadan, Nigeria

Background: Labor is considered to be one of the most painful experiences in life. Several efforts have been made over the years, particularly in the developed world, to relieve pain in labor. Unfortunately, the same attention has not been given to obstetric analgesia in most of Africa. Aim: To compare the analgesic efficacy, patient satisfaction, and side effects of intramuscular tramadol and paracetamol as pain relief among women in labor at University College Hospital (UCH), Ibadan, Nigeria. Materials and Methods: This was a prospective double-blind randomized controlled trial that recruited 142 parturients into two groups of 71 women. One group received intramuscular 600 mg paracetamol and the other 100 mg tramadol at recruitment with rescue dose at least 3 h apart. Maternal vital signs were monitored and labor pain was assessed using the numerical rating scale. Neonatal conditions were assessed by the use of APGAR scoring system and the need for admission into the Special Care Baby Unit. The parturients overall satisfaction with the analgesia were assessed 24 h postpartum. Results: The sociodemographic characteristics of the pregnant women in the two groups were similar, with the mean ages being 30.89 ± 3.50 and 30.93 ± 3.82 years, respectively. The study showed that intramuscular paracetamol was as effective as intramuscular tramadol for providing moderate pain relief during active phase of labor. Neither drug caused significant changes in maternal vital signs, with favorable neonatal outcome and good safety profile. Conclusions: This study showed that 600 mg intramuscular paracetamol provides similar and modest pain relief in labor when compared to 100 mg intramuscular tramadol. It also has fewer maternal adverse effects and favorable neonatal outcome such as tramadol. It is concluded that intramuscular paracetamol is simple, cost-effective, readily available, and feasible option as labor analgesics, especially for resource poor settings.

The Antacid and Analgesic Efficacy of Intramuscular Tramadol in Patients Undergoing General Anaesthesia

The Antacid and Analgesic Efficacy of Intramuscular Tramadol in Patients Undergoing General Anaesthesia

Methoxyflurane: A Review in Trauma Pain.

Methoxyflurane (Penthrox®) is a halogenated ether first used clinically as a volatile inhalational anaesthetic. It has been used as an analgesic in Australia and New Zealand for the past 30years. In the UK and Europe, methoxyflurane has been approved for the emergency relief of moderate to severe trauma pain in conscious adult patients. Methoxyflurane is self-administered using a hand-held inhaler. This article reviews the pharmacological properties of methoxyflurane and its clinical efficacy and tolerability in these patients. In the phaseIII STOP! trial, methoxyflurane was effective and generally well tolerated for the management of acute pain due to minor trauma, with a rapid onset of analgesia. In a prospective study, methoxyflurane was more effective than intramuscular tramadol when administered for the treatment of acute musculoskeletal pain in the pre-hospital setting (i.e. by paramedics). Methoxyflurane had a more rapid onset of action than tramadol when administered for the treatment of pain related to ankle injuries in the emergency department. Although methoxyflurane is known to be potentially nephrotoxic at anaesthetic doses, the much lower doses used for pain relief were not associated with nephrotoxicity or an increased risk of renal disease. Inhaled methoxyflurane may offer advantages over other analgesics administered via the intravenous, intramuscular or intranasal routes in terms of its non-invasive self-administration, ease of use and/or rapid onset of action. As such, it is a useful additional treatment option for the management of trauma pain in the pre-hospital or emergency department setting.

Comparison of analgesic effects of epidural Morphine versus lumbosacral plexus block in elderly patients undergoing hip joint replacement

Objective To compare the analgesic effects of epidural Morphine versus lumbosacral plexus block in patients undergoing hip joint replacement. Methods A total of 94 ASA Ⅰ~Ⅱ patients undergoing hip surgery with combined spinal epidural anesthesia(CSEA) were selected and randomized into 4 groups: Group M received a single epidural injection of 2 mg Morphine for analgesia, Group MN1 received an epidural injection of 1 mg Morphine combined with lumbosacral plexus block, Group MN2 received an epidural injection of 2 mg morphine combined with lumbosacral plexus block, and Group N received lumbosacral plexus block. All patients were administered intramuscular parecoxib for 3 days after surgery and, if the visual analogue scale(VAS)≥4, additional intramuscular tramadol. Patient-controlled intravenous analgesia(PCIA) was applied if pain relief was insufficient after Tramadol treatment. Postoperative analgesic effects, the ability to ambulate and side effects were monitored. Results VAS scores gradually increased in the 4 groups after surgery and were higher between the morning of the 1st day and the evening of the next day than at 4 hours after surgery in all the 4 groups. There were no significant differences in VAS scores between rest and exercise conditions in any of the 4 groups. Ambulatory VAS scores were lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery, while resting VAS scores had no significant differences between the 4 groups. Resting and ambulatory VAS scores were both lower in Groups MN1 and MN2 than in Groups M and N 6 hours after surgery, while they had no significant differences between either Groups MN1 and MN2 or Groups M and N 4-8 hours after surgery. Resting and ambulatory VAS scores were lower in Groups M, MN1 and MN2 than in Group M on the morning of the day after surgery, and more patients in Group N needed early tramadol and PCIA for rescue analgesia. Muscle strength was lower in Groups MN1 and MN2 than in Groups M and N 4 hours and on the morning of the day after surgery. No significant differences between the groups were found in standing ability 6 hours after surgery and in motor activity on the morning of the day after surgery. The incidence of urinary retention was higher in Groups M and MN2 than in Groups MN1 and N, and was higher in Group MN1 than in Group N. The incidence of pruritus was higher in Groups M and MN2 than in Group N. There was no significant difference in Ramsay sedation scores and postoperative nausea and vomiting(PONV) between the groups. Conclusions Epidural morphine combined with lumbosacral plexus nerve block can provide better analgesic effects than a single dose of epidural morphine or lumbosacral plexus nerve block in elderly patients undergoing hip joint replacement. Although the synergy of the combination has certain influence on early muscle strength recovery, it does not affect early postoperative rehabilitation training. With the combined use of parecoxib and lumbosacral plexus nerve block, epidural injection of 1 mg and 2 mg morphine provides similar analgesic effects, but epidural injection of 2 mg morphine results in a higher incidence of urinary retention. Thus, a small dose of epidural morphine combined with lumbosacral plexus nerve block is recommended for postoperative analgesia in elderly patients receiving hip joint replacement. Key words: Analgesia, epidural; Arthroplasty, replacement, hip; Morphine; Lumbosacral

Comparison of the effects of different analgesic methods in elderly patients undergoing hip surgery combined with low-molecular-weight heparin

Objective To compare the effects of different analgesic methods in patients undergoing hip surgery followed by low-molecular-weight heparin administration. Methods A total of 94 ASA Ⅰ-Ⅱ patients undergoing hip surgery with combined spinal and epidural anesthesia (CSEA) who had received a single dose of 2 mg epidural morphine were randomized into 3 groups: Group M (n=30, patients receiving a single dose of epidural morphine combined with intramuscular tramadol if VAS≥4), Group E [n=34, patients receiving a single dose of epidural morphine combined with patient-controlled epidural analgesia (PCEA)], and Group I [n=30, patients receiving a single dose of epidural morphine combined with patient-controlled intravenous analgesia (PCIA)]. Infusion quantity during operation, bleeding volume and postoperative drainage volume, visual analogue scales (VAS) 24 h and 48 h after operation, Ramsay sedation scores, and nausea and vomiting were recorded. Venous blood samples were taken at admission, the end of operation, and 24 h, 48 h and 7 d after operation for hemorheological data, coagulation tests and blood platelet counts (PLT). Color Doppler ultrasonography of lower limb vessels was conducted by the same clinician before and 7 days after operation. Results VAS at 48 h after operation were higher in Group M than in Group E and Group I, and there were more patients refusing to initiate ambulation because of pain in Group M than in Group E and Group I (P 0.05). The occurrence of post-operative nausea and vomiting (PONV) was higher in Group M and Group I than in Group E (P 0.05). Conclusions A single dose of epidural morphine does not achieve satisfactory analgesia, as evidenced by a large proportion of patients refusing to initiate rehabilitation training due to pain, and the incidence of PONV is high in elderly patients undergoing hip surgery. A single dose of epidural morphine combined with PCIA offers enhanced analgesia, but it also results in increased PONV. A single dose of epidural morphine combined with PCEA provides improved analgesia and reduced PONV, but shows no added advantage with the application of low-molecular-weight heparin in deep venous thrombosis prevention. Key words: Anesthesia and analgesia; Heparin, low-molecular-weight; Arthroplasty, replacement, hip

Anesthetic Management of an Orange-Spined-Hairy-Dwarf-Porcupine (Sphiggurus villosus) Undergoing Myelography

Background: The orange-spined hairy dwarf porcupine (Sphiggurus villosus) is a mammal that belongs to the rodentia order. Accidents involving this porcupine and dogs have become usual in some cities of Brazil. Dog bites may eventually result in spinal injuries. When there is clinical evidence of spinal cord injury, a myelography under general anesthesia may be required to allow identification of the exact location of the injury. To the authors’ knowledge, there is only one case report about anesthesia in Sphiggurus villosus where dissociative anesthesia was employed. This paper describes one case report of inhalation anesthesia with isoflurane in a Sphiggurus villosus undergoing myelography.Case: A 1.6 kg orange-spined hairy dwarf porcupine, with a history of dog bite was referred to the Veterinary Hospital of the University. On clinical examination, the patient was in good physical condition, alert, with an approximately 1-cm injury near the 10th and 11th thoracic vertebrae. Nociception in pelvic limbs was present whereas proprioception was absent. Radiographic examinations were suggestive of vertebral dislocation and fracture between the 10th and 11th thoracic verte­brae. A myelography was then requested by the responsible veterinarian. The porcupine received intramuscular midazolam (0.5 mg/kg) in combination with meperidine (10 mg/kg) as premedication. Anesthesia was induced and maintained with isoflurane in 100% oxygen via a face mask connected to a non-rebreathing circuit. Monitored variables at 5-min intervals included: pulse rate (PR) and systolic arterial blood pressure (SAP) measured by a Doppler ultrasound with its probe positioned at the palmar metacarpal artery; pulse oximetry (SpO2) measured by a sensor positioned at the tarsus; rectal temperature; and respiratory rate (RR). During the myelography, the range of values for the above mentioned variables were: PR, 189-206 beats/min; SAP, 90-130 mmHg; SpO2, 94-96%; RR, 32-40 breaths/min; and rectal temperature decreased by 0.5oC. Anesthetic recovery was uneventful. Postoperative pain relief was achieved with intramuscular tramadol (5 mg/kg).Discussion: To the authors’ knowledge, this is the first case report of inhalation anesthesia in a Sphiggurus villosus speci­men. In a previous case report, other authors described anesthesia for myelography in a porcupine with IM tiletamine/ zolazepam (5 mg/kg). In the case reported here, dissociative anesthetics, such as tiletamine, were avoided because these agents may increase intracranial pressure, cerebral blood flow and cerebrospinal fluid pressure, which are undesirable in patients with spinal trauma. Although physiologic variables were considered to be stable during anesthesia with isoflurane in this report, these findings have to be interpreted carefully. First, normal range of values for physiologic variables has not been reported for porcupines. Second, accuracy of the measurement techniques used (e.g. noninvasive measurement of SAP) has not been validated. Under the conditions reported in this case report, premedication with meperidine and mid­azolam was effective to induce good muscle relaxation and allowed anesthetic induction with isoflurane via a face mask. This anesthetic protocol provided adequate conditions for performing the myelography in a porcupine and physiologic variables remained stable throughout the procedure.Keywords: rodents, anesthesia, spinal trauma.

Comparison of the analgesic efficacy of oral ketorolac versus intramuscular tramadol after third molar surgery: A parallel, double-blind, randomized, placebo-controlled clinical trial.

BackgroundPreemptive analgesia is considered an alternative for treating the postsurgical pain of third molar removal. The aim of this study was to evaluate the preemptive analgesic efficacy of oral ketorolac versus intramuscular tramadol after a mandibular third molar surgery.Material and MethodsA parallel, double-blind, randomized, placebo-controlled clinical trial was carried out. Thirty patients were randomized into two treatment groups using a series of random numbers: Group A, oral ketorolac 10 mg plus intramuscular placebo (1 mL saline solution); or Group B, oral placebo (similar tablet to oral ketorolac) plus intramuscular tramadol 50 mg diluted in 1 mL saline solution. These treatments were given 30 min before the surgery. We evaluated the time of first analgesic rescue medication, pain intensity, total analgesic consumption and adverse effects.ResultsPatients taking oral ketorolac had longer time of analgesic covering and less postoperative pain when compared with patients receiving intramuscular tramadol.ConclusionsAccording to the VAS and AUC results, this study suggests that 10 mg of oral ketorolac had superior analgesic effect than 50 mg of tramadol when administered before a mandibular third molar surgery. Key words:Ketorolac, tramadol, third molar surgery, pain, preemptive analgesia.

Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies.

Background and Aims:Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology.Methods:Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E) group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T) group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score.Results:Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001) regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group.Conclusion:Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia.

Laser Acupuncture for Postoperative Pain Management in Cats.

The aim of this study was to evaluate laser acupuncture as an adjuvant for postoperative pain management in cats. Twenty cats, undergoing ovariohysterectomy, were sedated with intramuscular (IM) ketamine (5 mg kg−1), midazolam (0.5 mg kg−1), and tramadol (2 mg kg−1). Prior to induction of anaesthesia, the subjects were randomly distributed into two groups of 10 cats: Laser: bilateral stomach 36 and spleen 6 acupoints were stimulated with infrared laser; Control: no acupuncture was applied. Anaesthesia was induced using intravenous propofol (4 mg kg−1) and maintained with isoflurane. Postoperative analgesia was evaluated by a blinded assessor for 24 h following extubation using the Dynamic Interactive Visual Analogue Scale and Multidimensional Composite Pain Scale. Rescue analgesia was provided with IM tramadol (2 mg kg−1), and the pain scores were reassessed 30 min after the rescue intervention. If the analgesia remained insufficient, meloxicam (0.2 mg kg−1 IM, single dose) was administered. Data were analyzed using t-tests, the Mann-Whitney test, and the Friedman test (P < 0.05). The pain scores did not differ between groups. However, postoperative supplemental analgesia was required by significantly more cats in the Control (5/10) compared with the Laser group (1/10) (P = 0.038). Laser acupuncture reduced postoperative analgesic requirements in cats undergoing ovariohysterectomy.

Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labor

Study ObjectiveTo evaluate the efficacy and safety profile of paracetamol in comparison with tramadol for pain relief during active labor. DesignProspective, randomized, double-blind study. SettingMaternity Wing of the Postgraduate Institute of Medical Education and Research, Chandigarh. PatientSixty laboring, primiparous, full-term parturients with uncomplicated, singleton pregnancy in spontaneous labor and cervical dilatation of 3-5 cm. InterventionParturients were randomized into 2 groups to receive either 1 mg/kg of tramadol intramuscularly (group T; n = 29) or 1 g of paracetamol intravenously (group P; n = 30). Same doses of the drugs were repeated after 4 hours of initial dose. MeasurementPrimary outcome of the study was to assess the analgesic efficacy of the 2 drugs as measured by visual analog scale (VAS) score. Secondary outcome recorded was duration of labor, presence of any maternal, or fetal adverse events during the study. ResultsBoth the groups showed comparable VAS scores at all times of observation. Lower mean VAS scores were reported in both the groups till 120 minutes only. The duration of first stage of labor was shorter in group P (248.00 ± 98.171 vs 340.63 ± 111.592 minutes; P = .003). The duration of second stage of labor was comparable between the 2 groups. Higher incidence of maternal side effects such as nausea/vomiting and sedation was associated with the use of tramadol. Neonatal outcome was comparable. ConclusionIntravenous paracetamol provides comparable analgesia as intramuscular tramadol during active labor.

Intravenous paracetamol infusion versus intramuscular tramadol as an intrapartum labor analgesic.

To compare intravenous paracetamol and intramuscular tramadol as labor analgesics. This prospective-randomized study conducted in 200 primigravidae in active labor, distributed into two groups of 100 women each with one receiving intravenous 1,000mg Paracetamol and other 100mg intramuscular tramadol. Pain intensity is recorded by McGills scale before, one and 3h after drug administration. Perinatal outcome is recorded. No difference in pain intensity is seen before drug administration. After 1h of drug administration, in paracetamol group, 4% women had horrible pain, and 29% had distressing pain, while in tramadol group, 30% women had horrible pain, and 60% had distressing pain. After 3h of drug administration, in paracetamol group, 26% had distressing pain, while in tramadol group, 51% women had horrible pain, and 35% had distressing pain. Labor duration in paracetamol and tramadol group was 4.3 and 5.9h, respectively. In paracetamol group, nausea is seen in 2.2% and vomiting in 1.1%, while in tramadol group, nausea is seen in 6.4% and vomiting in 4.3%. Intravenous paracetamol is more effective labor analgesic with fewer maternal adverse effects and shortens labor as compared to intramuscular tramadol.

Labour Analgesia When Epidural Is Not a Choice: Tramadol versus Pentazocine.

Background. Parenteral opioids, thus, are still popular for pain relief in labor in many countries throughout the world. Aim. To evaluate and compare the efficacy of intramuscular tramadol and pentazocine in the first stage of labor. Method. Sixty-five patients were divided into pentazocine group and tramadol group. Subjects received either 30 mg pentazocine or 1 mg/kg tramadol intramuscularly. Pain was assessed using visual analog scale (VAS) before the administration of the drug, at 1 h, 2 h, 4 h, and at full dilatation. Maternal and neonatal side effects were determined. Results. Analgesic effect of the two drugs was not significantly different. Neither of these analgesics was effective towards the end of the first stage. However, in the tramadol group, the majority of women (55%) rated pain as severe, whereas in the pentazocine group, the majority of women (60%) rated pain as moderately severe. There were not many side effects with either of the drug in the given dosage. Mean injection to delivery interval was significantly shorter in the tramadol group as compared to the pentazocine group. Conclusion. Pentazocine or tramadol can be given for labor pain relief as an alternative to epidural analgesia in resource poor setting.

EVALUATION OF HAEMATOLOGICAL AND BIOCHEMICAL CHANGES AFTER SHORT TERM TRAMADOL USAGE IN HEALTHY DOGS

Tramadol is a synthetic, centrally acting opioid analgesic that has the best analgesic efficacy without excessive sedation and significant side effects in the postoperative pain relief in dogs. OBJECTIVES: In this study, hematological and biochemical changes due to short usage of tramadol were assessed in clinically healthy dogs. METHODS: For this purpose, eighteen male mongrel dogs aged 14 to 22 months were used in three equal groups. In the first and second groups respectively (2 and 5 mg/kg) intramuscular tramadol and in control group distillate water was given once a day for five consecutive days. Complete cell blood count (CBC) and biochemical evaluation were done to measure aspartate amino-transferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatinin (Cr), and blood urea nitrogen (BUN) levels, before the intervention (day 0) and on days 6 and 13, post-treatment. RESULTS: Thirteen days post treatment, Red blood cell (RBC) and white blood cell (WBC) count and ALT, AST, ALP, Cr, BUN and packed cell volume (PCV) level was measured as 6.75±0.03, 3.86±0.13, 40.00±7.98, 43.67±8.62, 57.00±17.03, 0.90±0.27, 25.00±5.48 and 40.13±2.88 respect-ively which showed that short-term injection of even high doses of tramadol creates no significant change on hematological, liver, and kidney parameters in dogs. CONCLUSIONS: The present study suggests that tramadol could be a safe postoperative analgesic for control of acute pain in dogs referred for routine surgical procedures.