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Tramadol Research Reports

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Tramadol Exposures Reported to Statewide Poison Control System.

Marquardt KA, Alsop JA, Albertson TE.

California Poison Control System, Sacramento Division; Associate Clinical Professor of Pharmacy, Division of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco; Clinical Professor of Medicine, Section of Medical Toxicology and Clinical Pharmacology, Division of Pulmonary and Critical Care, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA.

BACKGROUND: Tramadol is a unique analgesic that has been associated with seizures on overdose. OBJECTIVE: To determine the toxic effects associated with tramadol exposure. METHODS: A retrospective chart review of tramadol exposures reported to a multisite, state-wide poison control system over a 2.5-year period was performed. RESULTS: A total of 602 cases were retrieved; 190 had sufficient data for study evaluation. Cases with coingestants or unknown outcomes were eliminated. Of the 190 remaining cases, 55% were females. Acute ingestions represented 90.0%, chronic ingestions 7.9%, and acute on chronic 2.1% of the overdoses. Ages of the patients ranged from 9 months to 80 years. Suicide attempts represented the largest group of exposures. Main symptoms included central nervous system (CNS) depression (27.4%), nausea and vomiting (21.1%), tachycardia (17.4%), and seizures (13.7%). Dosage ranged from a taste amount to 5000 mg. The smallest amount of tramadol associated with seizure was 200 mg, and 84.6% of seizures occurred within 6 hours of time of ingestion. Logistic regression analysis showed an association between seizures and tramadol use in males, chronic use, suicide attempts, intentional abuse or misuse, and tachycardia (HR >100 beats/min). No effect was seen in 36.3% of patients, minor effects in 43.7%, moderate effects in 19.5%, and major effects in 0.5%. Symptoms resolved within 24 hours in 96.7% of the 121 patients who had symptoms. Naloxone improved CNS depression in 7 of 8 patients in whom a response was documented. CONCLUSIONS: Tramadol overdoses frequently cause CNS depression, nausea/vomiting, tachycardia, and seizures. Symptoms generally resolve within 24 hours. Accidental ingestions in children were well tolerated, primarily causing sedation.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15870139&query_hl=2

The use of tramadol and morphine for pain relief after abdominal hysterectomy.

Kocabas S, Karaman S, Uysallar E, Firat V.

Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Turkey.

OBJECTIVE: The aim of this study was to determine whether the addition of a tramadol infusion to morphine patient-controlled analgesia (PCA) results in improved analgesic efficacy compared with morphine PCA alone after abdominal hysterectomy. METHODS: Sixty patients undergoing abdominal hysterectomy were randomized into two groups, each receiving IV morphine PCA after surgery. The tramadol group received a loading dose of tramadol (1 mg/kg) at skin closure and a postoperative infusion of tramadol at 0.2 mg/kg/h. The control group received an equivalent volume of saline at skin closure and a postoperative saline infusion. RESULTS: The addition of a tramadol infusion to morphine PCA was associated with lower pain scores, a reduction in PCA morphine requirements (27 +/- 4.6 mg vs 40.5 +/- 5.4 mg over 24 h) and improved patient satisfaction with pain relief (p < 0.05). No intergroup differences were found with regard to sedation, nausea and antiemetic use (p > 0.05). CONCLUSION: The addition of a tramadol infusion to morphine PCA resulted in improved analgesic efficacy and reduced morphine requirements compared with morphine PCA alone after abdominal hysterectomy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15864937&query_hl=2

Pain management after lipoplasty: a study of 303 cases.

Manassa EH, Hellmich S, Ronert M, Hofheinz H, Olbrisch RR.

Department of Plastic Surgery, Florence Nightingale Hospital, Kaiserswerther Diakonie, Dusseldorf, Germany. dr.manassa@web.de

BACKGROUND: The safety and efficiency of liposuction have been proven in several studies, but little attention has been paid to postoperative pain. The present study was designed to determine the demand for analgesic agents used postoperatively after liposuction. METHODS: A total of 303 patients underwent ultrasound-assisted liposuction between January 1, 1999, and February 1, 2002, in the Department of Plastic Surgery at the Florence Nightingale Hospital, in Dusseldorf, Germany. The study is partly retrospective of the postoperative demand for analgesic agents. RESULTS: The study group of 244 female and 59 male patients was 42.2 +/- 13.6 years of age (range, 12 to 78 years). The average total suction volume removed was 2404.6 +/- 1704.2 cc (range, 90 to 9100 cc). Of 303 patients, 146 (48.2 percent) did not require any additional analgesic agents on the day of the operation, with 157 (51.8 percent) asking for pain relief on the operation day. On the first postoperative day, 88 (29.0 percent) of all liposuction patients asked for pain medication. That number of patients decreased to 28 (9.2 percent) on postoperative day 2, 21 (6.9 percent) on postoperative day 3, 11 (3.6 percent) on postoperative day 4, five (1.7 percent) on postoperative day 5, four (1.3 percent) on postoperative day 6, and zero on postoperative day 7. The data were further specified concerning details on analgesic agents. Of 303 patients, 146 (48.2 percent) did not require any form of pain medication. For 61 patients (20.1 percent), light analgesic agents were sufficient. Eighty-three patients (27.4 percent) asked for stronger medication, such as tramadol. Only 13 patients (4.3 percent) needed strong opioids for adequate pain management. No statistically significant difference concerning postoperative pain was observed between patients who were operated on under local anesthesia and those who received general anesthesia. CONCLUSIONS: This study gives clear proof that liposuction is a relatively painless procedure, and 48.2 percent off all liposuction patients do not need any pain medication at all. If they do need analgesic agents postoperatively, in most cases, analgesic therapy is sufficient with oral pain medication such as paracetamol or tramadol. In addition, patients can be reassured that merely 1 week after the operation very few patients complain of pain, and they can return to normal life without any complications concerning pain.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15861079&query_hl=2

Critical review of oral drug treatments for diabetic neuropathic pain-clinical outcomes based on efficacy and safety data from placebo-controlled and direct comparative studies.

Adriaensen H, Plaghki L, Mathieu C, Joffroy A, Vissers K.

Universitair Ziekenhuis Antwerpen, Edegem, Belgium.

The present review aims to evaluate the efficacy and safety of a selection of oral treatments for the management of painful diabetic neuropathy. A literature review was conducted retrieving placebo-controlled and direct comparative studies with a selection of oral treatments for painful diabetic neuropathy. All studies were analyzed with regard to efficacy and tolerability. Efficacy was evaluated as the percentage improvement in pain intensity between baseline and endpoint. Tolerability was evaluated by means of study discontinuations due to adverse events and by incidence of drug-related adverse events.The analyzed trials enrolled different patient populations with mostly small numbers of patients. The great variability in dosages and dose titration schemes, cross-over designs with variable wash-out periods, and other design schemes made comparison between the different studies difficult. Gabapentin, lamotrigine, tramadol, oxycodone, mexiletine, and acetyl-L-carnitine were the only treatments studied in large (at least 100 patients), placebo-controlled parallel group trials.It is concluded that standardization in design and reporting for comparison of treatments is needed. Validated questionnaires for evaluation of the efficacy and safety should be further developed. Based on the reviewed randomised controlled trials, gabapentin shows good efficacy, a favourable side-effect profile with lack of drug interactions and therefore it may be a first choice treatment in painful diabetic neuropathy, especially in the elderly. However, head to head trials of current treatments are lacking and therefore randomized controlled trials are required to address this issue. Copyright (c) 2005 John Wiley & Sons, Ltd.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15858788&query_hl=2