Role of tramadol in reducing pain on propofol injection

Department of Anaesthesia, National University Hospital, Singapore.
Singapore medical journal (Impact Factor: 0.63). 05/2001; 42(5):193-5.
Source: PubMed

ABSTRACT Propofol is frequently associated with pain on injection. We evaluated the effect of tramadol in a randomised, double-blind study using a tourniquet venous retention technique. Normal saline placebo was given intravenously to patients in Group 1 (n = 30),tramadol 50 mg to Group 2 (n = 30), and lignocaine 50 mg to Group 3 (n = 30). The venous retention of drugs was maintained for 1 minute, followed by tourniquet release and intravenous administration of propofol. Pain assessment was made immediately after propofol injection. There was a significant reduction in the incidence of pain associated with propofol administration in patients pretreated with lignocaine and tramadol (P < 0.05). In addition, pretreatment with tramadol was as effective as lignocaine in reducing pain on propofol injection.

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    ABSTRACT: Tramadol is a centrally acting analgesic with μ-opioid and monoaminergic agonist effect. Ten healthy adult dogs were studied (mean ± SEM body weight 17.3 ± 3.8 kg), premedicated with acepromazine (0.05 mg/kg, IM), induced with thiopental (10 mg/kg, IV) and maintained under anesthesia with halothane in oxygen. Twenty minutes after starting halothane anesthesia, tramadol (1.0 mg/kg in 0.22 ml/kg of sterile water) was administered epidurally at the lumbo-sacral space. Surgery began 15 minutes later. Pulse and respiratory rates, systolic, mean and diastolic arterial blood pressure, and pulse oximetry were measu red before premedication (baseline), and at fixed intervals after anesthesia induction. Arterial pH, PaO 2, PaCO2, HCO3 - , and SaO2 were measured at baseline, immediately before the epidural, and 60, 120, 240 and 360 minutes thereafter. Post-operative analges ia was evaluated for four hours using a scoring system. Statistically significant decrease in arterial blood pressure was observed following anesthetic induction. The PaCO 2 increased significantly from baseline at 60 minutes after epidural tramadol. The remaining variables were not significantly different from baseline values. No variables were significantly different from value s obtained immediately before tramadol administration. Intraoperative antinociception was considered adequate, with satisfactory post-operative analgesia for four hours. In conclusion, epidural tramadol seems to produce satisfactory antinociception and analgesia without causing clinically significant hemodynamic and respiratory depression in healthy dogs undergoing stifle
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    ABSTRACT: Tramadol, a centrally acting analgesic structurally related to codeine and morphine, consists of two enantiomers, both of which contribute to analgesic activity via different mechanisms. (+)-Tramadol and the metabolite (+)-O-desmethyl-tramadol (M1) are agonists of the mu opioid receptor. (+)-Tramadol inhibits serotonin reuptake and (-)-tramadol inhibits norepinephrine reuptake, enhancing inhibitory effects on pain transmission in the spinal cord. The complementary and synergistic actions of the two enantiomers improve the analgesic efficacy and tolerability profile of the racemate. Tramadol is available as drops, capsules and sustained-release formulations for oral use, suppositories for rectal use and solution for intramuscular, intravenous and subcutaneous injection. After oral administration, tramadol is rapidly and almost completely absorbed. Sustained-release tablets release the active ingredient over a period of 12 hours, reach peak concentrations after 4.9 hours and have a bioavailability of 87-95% compared with capsules. Tramadol is rapidly distributed in the body; plasma protein binding is about 20%. Tramadol is mainly metabolised by O- and N-demethylation and by conjugation reactions forming glucuronides and sulfates. Tramadol and its metabolites are mainly excreted via the kidneys. The mean elimination half-life is about 6 hours. The O-demethylation of tramadol to M1, the main analgesic effective metabolite, is catalysed by cytochrome P450 (CYP) 2D6, whereas N-demethylation to M2 is catalysed by CYP2B6 and CYP3A4. The wide variability in the pharmacokinetic properties of tramadol can partly be ascribed to CYP polymorphism. O- and N-demethylation of tramadol as well as renal elimination are stereoselective. Pharmacokinetic-pharmacodynamic characterisation of tramadol is difficult because of differences between tramadol concentrations in plasma and at the site of action, and because of pharmacodynamic interactions between the two enantiomers of tramadol and its active metabolites. The analgesic potency of tramadol is about 10% of that of morphine following parenteral administration. Tramadol provides postoperative pain relief comparable with that of pethidine, and the analgesic efficacy of tramadol can further be improved by combination with a non-opioid analgesic. Tramadol may prove particularly useful in patients with a risk of poor cardiopulmonary function, after surgery of the thorax or upper abdomen and when non-opioid analgesics are contraindicated. Tramadol is an effective and well tolerated agent to reduce pain resulting from trauma, renal or biliary colic and labour, and also for the management of chronic pain of malignant or nonmalignant origin, particularly neuropathic pain. Tramadol appears to produce less constipation and dependence than equianalgesic doses of strong opioids.
    Clinical Pharmacokinetics 02/2004; 43(13):879-923. DOI:10.2165/00003088-200443130-00004 · 5.49 Impact Factor
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    ABSTRACT: Objective: To assess the potential of oral Clonidine premedication indecreasing patient discomfort during the injection of Propofol. Design: This was a comparative study of 80 ASA class1 and II. Place and Duration of study: This study was carried out at Combined Military Hospital, Kharian. Patients andMethods: This was a study of 80 ASA class 1 and 2 patients of similar age group. Patients selected were from amongstthose undergoing elective gynaecological surgery, specifically Diagnostic Dilatation and Curettage. These patients wereselected by non-probability convenience sampling. The patients were randomly assigned, by means of a random table,to one of the two groups of 40 patients each. Group ‘A’ patients were given oral Clonidine, 300mg two hours beforeinduction of anaesthesia by Propofol injection. Group B’ patients were given 0.01 to 0.02mg/kg plain Lidocaine justbefore Propofol induced anaesthesia. Non-invasive systolic arterial blood pressure (ni-SBP), non-invasive diastolicarterial blood pressure (ni-DBP) and heart rate were recorded in the ward about 120 min [before administration of oralClonidine in group-A] in both groups. Measurements were repeated in the operating theatre before induction ofanaesthesia. Patients in Group-A were given one tablet Catapres [Clonidine, 300mg] with a sip of water, two hoursbefore induction of anaesthesia and they were observed in the Post Anaesthesia Care Unit during this period, whiletheir pulse and blood pressure were monitored. Patients in group-B were not premedicated with Clonidine. They wereinjected 0.01 to 0.02mg/kg injection plain lidocaine, through the injection port of an 18-gauge cannula, as premedicationjust before propofol monitoring was done as for group-A. Before administration of propofol, the patient was requestedto rate immediately any sensation of pain during injection as none (0), mild (1), moderate (2) or severe (3), also calledthe Verbal Rating Scale (VRS). Results: The results showed both groups to have similar pain score, and differenceswere deemed statistically not significant by the analysis. Conclusion: Our results imply that Clonidine makes anexcellent premedication with Propofol for short gynaecological procedures.
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