Safety and efficacy of "on-demand" tramadol in patients with premature ejaculation: an updated meta-analysis

ABSTRACT Introduction: Tramadol has been used for the treatment of premature ejaculation, however, the studies published for the same are not well designed. The primary objective of this study was to explore the literature pertaining to the use of tramadol in patients with PE to determine its safety and efficacy in this population. Materials ande methods: Systematic literature search of various electronic databases was conducted to include all the randomized studies and quasi-randomized studies. Standard PRISMA (Preferred reporting Items for Systematic reviews and Meta-analysis) guidelines were pursued for this review and study protocol was registered with PROSPERO (CRD42019123381). Results: Out of 9 studies included in this review, 5 were randomized controlled trials, and rests of the 4 studies were quasi-randomized studies. Tramadol resulted in significantly higher improvement of IELT with the mean difference (MD) of 139.6 seconds and confidence interval (CI) 106.5-172.6 seconds with a p-value of p <0.00001. All dosages except 25mg fared well as compared to placebo. Tramadol fared better than placebo at 1 month, 2 months, and 3 months after initiation of therapy as compared to the placebo. Tramadol group had reported a significantly higher number of adverse events with treatment as compared to placebo but none of them were serious. Conclusion: Tramadol appears to be an effective drug for the management of PE with a low propensity for serious adverse events. However, evidence obtained from this study is of low to moderate quality. Furthermore, effective dose and duration of therapy remain elusive.

Antinociceptive local activity of 4-allyl-1-hydroxy-2-methoxybenzene (eugenol) by the formalin test: an anti-inflammatory effect

Eugenol has been employed for decades as a condiment, an antimycotic, an antibacterial, an antiviral, and an antioxidant, and it is one of the natural analgesics most frequently utilized for pain and inflammation. Our objective was to determine the analgesic/anti-inflammatory effect of eugenol compared with diclofenac, naproxen, and tramadol using the formalin test. The formalin method was used in 6- to 10-week-old Wistar rats (weighing 250 g each) divided into six groups: saline (0.9%); formalin (5%); diclofenac (250 µg/kg); naproxen (400 µg/kg); tramadol (500 µg/kg), and eugenol (1,400 µg/kg), in the intraplantar part of the hind-end trunk of the rats, with n = 5 per group. Eugenol diminished 44.4% of nociceptive behavior in phase 1 and 48% in phase 2 (p ≤0.05 vs formalin). Eugenol was shown to be 1.14 times more effective than diclofenac, but 1.62 and 1.75 times less effective than naproxen and tramadol, respectively, in phase 1 and 1.45 times less effective than diclofenac and naproxen and 1.66 less effective than tramadol in phase 2 (p ≤0.05). These data suggest that eugenol possesses moderate activity in the acute pain phase and greater activity in inflammatory-type pain, and both effects are comparable to those produced by diclofenac and are less than the effects produced by naproxen and tramadol in the formalin test

Efeitos adversos da morfina, metadona e tramadol no pós-operatório de cães submetidos à cirurgia da coluna vertebral: 180 casos (2011-2016) / Adverse effects of morphine, methadone and tramadol in the postoperative period of dogs undergone vertebral surgery: 180 cases (2011-2016)

A dor pós-operatória em cães que são submetidos a cirurgias da coluna vertebral é considerada severa e seu manejo inadequado pode influenciar no tempo de recuperação do paciente, na qualidade de vida e no resultado cirúrgico. Dentre os analgésicos indicados para uso no pós-operatório dessas cirurgias tem-se os opioides, que podem apresentar inúmeros efeitos adversos que requerem atenção. Devido à escassez de estudos clínicos acerca desse assunto em se tratando do pós-operatório de cães, objetivou-se com o presente estudo retrospectivo apresentar os efeitos adversos da morfina, metadona e tramadol utilizados no pós-operatório de cirurgias da coluna vertebral. Foram revisadas e avaliadas as fichas de 180 cães e anotadas as alterações observadas no pós-operatório e decorrentes do uso de opioides. Os principais efeitos adversos observados foram anorexia, hiporexia, vômito, salivação, vocalização, bradicardia, hipotermia, ofegação e sedação. Também foi observada persistência da dor em alguns cães mesmo com o uso de analgésicos. Houve diferença na ocorrência de anorexia nos cães tratados com morfina e nos tratados com metadona em relação aos tratados com tramadol. Ocorreu diferença também entre a observação de dor dos grupos morfina e tramadol. A associação de dipirona com morfina e com metadona não revelou diferença com relação à ocorrência de efeitos adversos, bem como a variação de doses. Conclui-se que a morfina, a metadona e o tramadol apresentam efeitos adversos quando empregados para tratamento da dor pós-operatória em cães submetidos à cirurgia da coluna vertebral; a anorexia, a hiporexia e o vômito foram os efeitos adversos frequentes com o uso de morfina e de metadona e, mesmo que o tramadol apresente menor ocorrência desses efeitos, seu uso, na dose estudada, pode não ser vantajoso quando se leva em consideração o grau de dor para cirurgias da coluna vertebral.(AU)

Postoperative pain in dogs undergone vertebral surgery is classified as severe and it's important an adequate approach to it, because it can influence recovery time, quality of life and surgery outcome. Opioids are indicated for postoperative pain treatment in these surgeries. Opioids may have adverse effects that may require attention. There are few clinical studies that present the adverse effects of these analgesics in canine postoperative period. The aim of this retrospective study was to present the adverse effects of morphine, methadone and tramadol in canine vertebral surgery postoperative period. There were revised the postoperative records of 180 dogs and the changes resulted from the opioids use were noted. The adverse effects observed were anorexia, hyporexia, vomiting, vocalization, bradycardia, hypothermia, panting, sedation. Pain was also observed in some dogs. A significant difference was found in anorexia between dogs treated with morphine and tramadol and methadone and tramadol. Significant difference was also found in pain between dogs treated with morphine and tramadol. The association of metamizole and morphine or metamizole and methadone was not different in relation to the adverse effects. There was also no difference with the dosage variation and the adverse effects. In conclusion, morphine, methadone and tramadol have adverse effects when used for pain control in the postoperative period of dogs submitted to vertebral surgery. Anorexia, hypophagia and emesis were frequent the adverse effects observed with morphine and methadone and, despite tramadol presented less adverse effects, its use may be not beneficial in the studied doses when we consider the degree of pain, however more controlled studies with clinical situation are needed to confirm this.(AU)

Uso do tramadol venoso e subcutâneo em herniorrafia inguinal: estudo comparativo / Intravenous and subcutaneous tramadol for inguinal herniorrhaphy: comparative study / Uso del tramadol venoso y subcutáneo en herniorrafía inguinal: estudio comparativo

JUSTIFICATIVA E OBJETIVOS: A herniorrafia inguinal é uma das cirurgias mais realizadas no homem. O bloqueio do neuroeixo é a técnica anestésica comumente utilizada e, na maioria das vezes, o paciente se encontra em condições para alta domiciliar algumas horas após o procedimento, desde que apresente analgesia satisfatória e ausência de náuseas e vômitos. O tramadol é um fármaco analgésico que pode ser utilizado para a analgesia pós-operatória, porém apresenta, como importantes efeitos colaterais, a presença de náuseas e vômitos, cuja incidência pode variar de 0 por cento a 50 por cento associada ao seu uso. O objetivo deste estudo foi comparar a incidência de náuseas e vômitos e a qualidade da analgesia pósoperatória do tramadol pela via subcutânea e endovenosa em pacientes submetidos à herniorrafia inguinal. METÓDO: Estudo prospectivo com 30 pacientes submetidos à herniorrafia inguinal. Foram divididos em dois grupos: Grupo C (n = 15) recebeu Tramadol 1,5 mg.kg-1 subcutâneo e Grupo V (n = 15) recebeu Tramadol 1,5 mg.kg-1 endovenoso. Para todos os pacientes, fez-se anestesia peridural contínua com levobupivacaína a 0,5 por cento. Foram registrados os dados antropométricos, qualidade de analgesia e ocorrência de náuseas e vômitos nas primeiras 8 horas do pós-operatório. RESULTADOS: Não houve diferença estatística entre os grupos com relação aos dados antropométricos, qualidade da analgesia e ocorrência de náuseas e vômitos. CONCLUSÕES: Conclui-se, neste estudo, que não existe diferença estatisticamente significante quanto à incidência de náuseas e vômitos e à qualidade da analgesia quando se utiliza o tramadol por via venosa e subcutânea.

BACKGROUND AND OBJECTIVES: Inguinal herniorrhaphy is one of the most common surgeries in men. Neuroaxis block is the anesthetic technique used more often and in the majority of the cases the patient is ready to be discharged from the hospital a few hours after the procedure, as long as satisfactory analgesia is present and nausea and vomiting are absent. Tramadol is an analgesic drug that can be used in postoperative analgesia, but it has important side effects, such as nausea and vomiting whose incidence can range from 0 percent to 50 percent. The objective of the present study was to compare the incidence of nausea and vomiting and the quality of postoperative analgesia of subcutaneous and intravenous tramadol in patients undergoing inguinal herniorrhaphy. METHODS: This is a prospective study with 30 patients undergoing inguinal herniorrhaphy. Patients were divided into two groups: Group C (n = 15) received 1.5 mg.kg-1 of subcutaneous Tramadol, and Group V (n = 15) received 1.5 mg.kg-1 of intravenous Tramadol. All patients underwent continuous epidural anesthesia with 0.5 percent levobupivacaine. Anthropometric data, quality of analgesia, and the development of postoperative nausea and vomiting in the first eight hours were recorded. RESULTS: Statistically significant differences were not observed between both groups for anthropometric data, quality of analgesia, and the development of nausea and vomiting. CONCLUSIONS: The present study demonstrates the absence of statistically significant differences regarding the incidence of nausea and vomiting and quality of analgesia when using intravenous and subcutaneous Tramadol.

JUSTIFICATIVA Y OBJETIVOS: La herniorrafía inguinal es una de las cirugías más realizadas en el hombre. El bloqueo del neuro eje es la técnica anestésica más utilizada y en la mayoría de los casos, el paciente está en condiciones de recibir el alta algunas horas después del procedimiento, siempre que presente analgesia satisfactoria y la ausencia de náuseas y vómitos. El tramadol es un fármaco analgésico que puede ser utilizado para la analgesia postoperatoria, pero que presenta, como importantes efectos colaterales, náuseas y vómitos, y su incidencia puede variar de 0 por ciento a 50 por ciento, dependiendo del uso. El objetivo de este estudio fue comparar la incidencia de náuseas y vómitos y la calidad de la analgesia postoperatoria del tramadol por la vía subcutánea y endovenosa en pacientes sometidos a la herniorrafía inguinal. MÉTODOS: Estudio prospectivo con 30 pacientes sometidos a la herniorrafía inguinal. Se dividieron en dos grupos: Grupo C (n = 15) que recibió Tramadol 1,5 mg.kg-1 subcutáneo y el Grupo V (n = 15) que recibió Tramadol 1,5 mg.kg-1 endovenoso. A todos los pacientes se les practicó la anestesia epidural continua con levobupivacaína a 0,5 por ciento. Fueron registrados los datos antropométricos, la calidad de la analgesia y la incidencia de náuseas y vómitos en el postoperatorio (en las primeras ocho horas). RESULTADOS: No hubo diferencia estadística entre los grupos con relación a los datos antropométricos, calidad de la analgesia e incidencia de náuseas y vómitos. CONCLUSIONES: En este estudio llegamos a la conclusión de que no existe diferencia estadísticamente significante cuanto a la incidencia de náuseas y vómitos y a la calidad de la analgesia cuando se utiliza el tramadol por vía venosa y subcutánea.

Tramadol induced seizure: report of 106 patients

Seizure is one of the possible adverse effects of tramadol hydrochloride, a synthetic, centrally-acting analgesic, prescribed for the treatment of moderate to severe pain. In this study, we describe 106 patients with tramadol induced seizures. The patients, who were referred to Nemazee Hospital, Shiraz, Iran, from March 2006 to March 2008, were examined in this cross-sectional study. All of the patients had experienced seizure[s] after ingesting tramadol. Each patient was interviewed for demographic data, history of epilepsy, family history of epilepsy, duration of tramadol use, total dose and the last dose of ingested tramadol. Neurological examinations, routine laboratory tests, electroencephalography, and brain computed tomography were performed for each patient. One hundred and six patients were studied [102 males and 4 females, mean age: 26.7 +/- 6 g years]. Among them, 92 [86.8%] had new-onset provoked seizure[s] induced by tramadol and in 14 patients [13.2%], tramadol ingestion was considered as a precipitating factor in the setting of previously-known epilepsy. Tramadol was prescribed by the physicians for alleviation of pain in 20 patients [18.9%] and abused in the remainder [86 patients, 81.1%]. The dose of ingested tramadol before the seizure[s] was 50 to 1500mg. Tramadol may provoke seizures in patients with epilepsy and also in previously healthy people even within the recommended dose ranges. Because most of the cases had occurred in young abusers, strategies to prevent tramadol addiction should be sought

Control of post-surgical pain; comparison between tramadol and meperidine after emergency cesarean section

There are many complications for patients with post cesarean section relative pain. So it delays in discharging or increasing in hospital stay. The objective of this study was a comparison between Tramadol and Meperidine according to pain relief or other possible complications in post cesarean section pain control. This study was a double blind clinical trial. It arranged for 240 parturients who scheduled for emergency cesarean section with pain after surgery in spite of spinal anesthesia. All patients were in ASA class I. They were divided randomly in two groups. Meperidine [M] and Tramadol [T] groups with 120 patients in each group. After beginning of pain in post anesthesia care unit [VAS> or=4], in group [T] tramadol 1.5 mg/kg and in group [M] meperidine 0.5 mg/kg were injected intravenously. Apart from pain, other drug complications such as shivering, blood pressure changes, itching, nausea and vomiting, drowsiness were recorded one and two hours after injection. Data were analyzed by chi-square test, Relative frequency rate [RFR] of 50% decrease in pain score one hour after intravenous injection was 56.7% in group [T] and 69.2% in group [M] [P=0.054]. RFR for respiratory depression after one hour was 5.8% in [M] group and 0 in [T] group [P=0.007]. RFR for nausea after one hour was 39.2% in [T] group and 23.3% in [M] group [P=0.008]. RFR for vomiting after one hour was 23.3% in [T] group and 13.3% in [M] group [P=0.045]. RFR for drowsiness after one hour was 25% in [M] group and 3.3% in [T] group [P=0.007]. There was no statistically significant relationship after 2[nd] hour for pain relief, nausea, vomiting and drowsiness between two groups. There was no difference between two groups in RFR for shivering, blood pressure changes and itching in both two groups. This study illustrates both remedies Meperidine and Tramadol which were effective for pain relief and shivering after cesarean section. But according to high incidence of nausea and vomiting with Tramadol and more analgesic effects of Meperidine than Tramadol, administration of Meperidine is better than Tramadol after cesarean section for pain control

Detección de efectos secundarios asociados a la administración de tramadol y dipirona en un hospital de alta complejidad / Adverse events associated with tramadol and dipirona administration in a level III hospital

Introducción. Un objetivo prioritario después de la comercialización de medicamentos, como la dipirona y el tramadol, en grupos particulares de población, como el colombiano, es garantizar la eficacia y la seguridad. Objetivo. Describir y estimar la frecuencia de efectos secundarios, incluida la falla terapéutica, asociados al uso de tramadol y a la dipirona en el Hospital Universitario de La Samaritana (III nivel). Materiales y métodos. Se hizo seguimiento intensivo de los efectos secundarios asociados a la dipirona y al tramadol en los pacientes hospitalizados en los Servicios de Medicina Interna, Ortopedia y Cirugía, durante un período de seis meses como parte de un proyecto a un año. La información se recolectó mediante el formato para reporte al Instituto Nacional de Vigilancia Médica y Alimentos, INVIMA. La probabilidad de causalidad se estableció mediante el algoritmo de la Organización Mundial de la Salud. Se calcularon los costos directos desde la perspectiva del pagador. Resultados. Se detectaron 213 efectos secundarios en 171 de los 2.547 pacientes que ingresaron a los servicios (proporción de incidencia, 8,4%). El 53,4% se clasificó como posible para la dipirona y 46,82% para el tramadol; el 0,62%, (16 casos) correspondió a efectos secundarios serios. El sistema más frecuentemente afectado fue el gastrointestinal: dipirona, 27%, y tramadol, 42,9%. El costo generado por la atención de los efectos secundarios a los medicamentos del estudio fue de US$ 14.346,53. Conclusiones. El impacto negativo de los efectos secundarios de los medicamentos, los recursos que se emplean en su atención y la capacidad de prevenirlos, demuestran que se requieren programas institucionales de farmacovigilancia.

Introduction. The efficacy and safety of pharmaceutical drugs such as dipirone and tramadol must be a primary objective in the post-marketing period and as they are used in specific population groups. Objectives. The frequency of adverse effects (including therapeutic failure) with the medications tramadol and dipirona were described and estimated. Material and methods. At the Hospital Universitario de la Samaritana, Bogotá, D.C., Colombia, adverse events associated with dipirone and tramadol were rigorously tracked in patients hospitalized in the internal medicine, as well as the orthopedics and surgery departments. For a period of six months, data were collected by means of the Instituto Nacional de Vigilancia Médica y Alimentos (INVIMA) standard report form. Direct costs of adverse event treatment to the patient were calculated. Results. Adverse reactions were detected 213 times in 171 (8.4%) of the 2,547 patients admitted to the services (incidence rate). Of these instances, 53.4% were rated as possible for dipirone and 46.82% for tramadol. Of the total, 0.6% (16 cases) were classes as serious adverse events. The gastrointestinal system was the most affected, with the incidences of adverse events for dipirone of 27%) and tramadol of 42.9%. The total cost generated by the medical response to the 213 adverse events was estimated to be US$14,346.53. Conclusions. An unacceptable level of preventable adverse events was described that impacted the well-being of patients, as well as the costs associated with remedial treatment. These data recommend that institutional pharmacovigilance programs be required.

Variáveis cardiorrespiratórias, índice biespectral e recuperação anestésica em cães anestesiados pelo isofluorano, tratados ou não com tramadol / Cardiorespiratory variables, bispectral index and recovery of anesthesia in dogs anesthetized with isoflurane, treated or not with tramadol

Foram avaliadas possíveis alterações cardiorrespiratórias e no índice biespectral em cães anestesiados pelo isofluorano, associado ou não ao tramadol. Utilizaram-se 16 animais, distribuídos em dois grupos denominados GC (grupo-controle) e GT (grupo tramadol). Todos os cães foram induzidos e mantidos sob anestesia com isofluorano. Os animais do GC receberam 0,05ml/kg de solução salina a 0,9 por cento e os do GT 2mg/kg de tramadol, ambos por via intramuscular. Foram avaliados: freqüência cardíaca, pressão arterial sistólica, diastólica e média, eletrocardiografia, freqüência respiratória, saturação de oxiemoglobina, concentração de dióxido de carbono ao final da expiração, índice biespectral e recuperação da anestesia. Concluiu-se que a administração de tramadol em cães anestesiados pelo isofluorano não produz alterações nas variáveis cardiorrespiratórias, no índice biespectral e no tempo de recuperação da anestesia, porém proporciona boa qualidade de recuperação anestésica.

It was studied fortuitous cardiorespiratory and bispectral index changes in dogs anesthetized with isoflurane associated or not to tramadol. Sixteen dogswere distributed in two groups named CG (control group) and TG (tramadol group). General anesthesia was induced in all animals with isoflurane via mask. After 10 minutes, the animals of CG received 0.05ml/kg of saline solution at 0.9 percent, and TG received 2mg/kg of tramadol, both via intramuscular. It was evaluated heart rate, systolic, diastolic and mean arterial pressures; electrocardiography; respiratory rate; oxihemoglobin saturation; end tidal carbon dioxide; bispectral index and recovery of anesthesia. The administration of tramadol in dogs anesthetized with isoflurane did not produce changes in cardiorespiratory variables, bispectral index and anesthetic recovery time. In addition, this association promoted good quality of anesthetic recovery.

Tromadol et dextropropoxyphene: comment eviter les risques inutiles aux patients

N.A.

Pre-emptive analgesia for laparoscopic surgery. a randomized, double-blind, placebo-controlled comparison between parecoxib sodium and tramadol

This study was performed to compare the preemptive effect of intravenous parecoxib vs intravenous tramadol as regards control of stress response to intubation and efficacy of analgesia, in adult patients undergoing laparoscopic surgery. Forty five adult patients ASA physical status I-II scheduled to undergo abdominal laparoscopic surgery were included in this study. Patients were randomly divided into three equal groups. Group I [n = 15] received parecoxib [40 mg iv]. Group II [n = 15] received tramadol [100 mg iv]. Group III [n = 15] received placebo [10 ml normal saline iv]. Anesthesia was induced 10 minutes later using propofol [2 mg/kg] and fentanyl [1-2 micro g/kg]. Tracheal intubation was facilitated using succinyl choline [1.5 mg/kg]. Maintenance of anesthesia was achieved using isoflurane [0.6% - 1.5% according to blood pressure] in a mixture of 50% N[2]O in oxygen. Intraoperative muscle relaxation was maintained using atracurium [0.5 mg/kg followed by 0.1 mg/kg every 20 min]. Mechanical ventilation parameters were adjusted to maintain end-tidal CO[2] [ETCO[2]] at normal levels. Surgery was performed using standard techniques. Catecholamine levels [adrenaline and noradrenaline] were measured 1 minute before and 1 minute after intubation. Heart rate [HR], systolic [SBP] and mean arterial blood pressures [MBP] were recorded 1 minute before, and then every 1 minute after intubation, for 5 minutes. Postoperatively, patients received a continuous infusion of iv morphine at a rate of 0.03 mg/kg/hr. When requested, an additional [rescue] dose of morphine was administered at a dose of 0.05 mg/ kg, to a maximum of one rescue dose per 6 hours. The time till request of the first rescue dose, the number of rescue doses given, and the total rescue morphine dose given were recorded. Patients were observed for the first 24 hrs after surgery for occurrence of nausea and/or vomiting, and pruritis. Data was recorded at 8 hour intervals [8, 16 and 24 hrs after surgery]. There were no intergroup differences as regards age, gender, height or weight. Time to intubation, duration of surgery, doses of propofol and fentanyl used were also similar in-between the groups. Catecholamine levels increased significantly from baseline after intubation in all groups [P < 0.05], but the increase was significantly less in group II [tramadol] than in group I [parecoxib], and both study groups showed a lesser increase compared to placebo [P < 0.05]. Relative to baseline, HR, SBP and MBP increased significantly after intubation in all groups. This increase was significantly greater in group III [P < 0.05]. The tramadol group showed a slightly lesser increase in HR, SBP and MBP compared to the parecoxib group [P < 0.05], but these differences were not clinically significant. Patients in the parecoxib group showed a longer time [median] to first request of rescue analgesia [11.6 hrs] as compared to the tramadol group [7.2 hrs]. Both groups were superior to placebo [3.9 hrs to rescue dose, P < 0.05]. A similar trend was shown in the number, and total dose of rescue morphine, in-between the groups. Nausea and/or vomiting was greatest in the tramadol group [P < 0.05], and more pronounced in all groups in the first 8 hours after surgery. Pruritis was an isolated finding in the tramadol, group; none of the patients in the other two groups complained of pruritis. Both parecoxib and tramadol are effective agents as preemptive analgesics for laparoscopic surgery. While tramadol can have a more stable hemodynamic profile, parecoxib provides a more intense analgesic effect, with a hemodynamic profile that is not clinically inferior to tramadol. The use of tramadol, however, can be associated with more side effects, such as nausea, vomiting, and pruritis

Comparison of oral tramadol and tolmetin in relieving pain of knee osteoarthritis

The aim of this double blind crossover study was to compare the efficacy of oral tramadol with that of tolmetin [NSAID] in relieving pain of patients with chronic pain due to osteoarthritis of the knee. After baseline observation, 44 patients were assigned to one of the two treatment sequences and 40 patients completed the study. During the two treatment periods, the patients daily ratings of pain on a 0- 10 numeric rating scale throughout baseline and double blind treatment periods served as the primary outcome measure. Their ratings for pain were not significantly different between tramadol and tolmetin. It was concluded that though tolmetin was little more effective in relieving the pain and was of less side effects, both tramadol and tolmetin relieved pain due to knee osteoarthritis

Eficacia analgesica e tolerabilidade do tramadol / Analgesic efficaccy and tolerability of tramadol

Em estudo aberto,com 1355 pacientes,foi avaliada a eficacia e seguranca do tramadol,por 225 medicos de varias especialidades.Dos pacientes,524(45,6 pr cento)foram atendidos em unidades de internacao e 831(54,4 por cento) emunidades ambulatoriais.Em 94,6 por cento dos casos as idades variaram entre 13 e 75 anos.Na maioria das vezes 94 por cento a dor era moderada ou intensa.A dor se originou de traumatismos operatorios em 50,2 por cento dos casos,traumatismo acidentais e fraturas em 12,0 por cento anormalidades do aparelho locomotor em 29,3 por cento e neoplasias em 2,7por cento.A medicacao foi prescrita como ampolas,gotas,comprimidos esupositorios;mais de uma apresentacao foi empregada em 6,5por cento das ocasioes.A dose media inicial foi de 81mg e a dose media diaria de 195mg.Tramadol foi utilizado varias vezes em 85,0 por cento dos doentes.A duracao do tratamento foi de uma semana em 73,0 por cento dos casose de ate duas semanas em 13,7 por cento.Ocorreu melhora inicial satisfatoria em 91 por cento dos doentes.A eficacia analgesica se manteve em 87,5 por cento dos casos.Efeitos colaterais,foram observados em 15 por cento dos casos;os mais frequentes foram nauseas,instabilidade da marcha,tonturas e sonolencia.Concluiu-se que o tramadol foi eficaz e seguro para o tratamento da dor aguda e da dor cronica

Efectos comparativos de fentanyl vs. tramadol en el control del dolor en el trabajo de parto

Objetivos: comparar la efectividad y seguridad de la analgesia epidural con un anestésico local (bupivacaína) con adición de opioide (fentanil o tramadol) durante la fase activa del trabajo de parto. Diseño: experimento clínico controlado, aleatorizado y doble ciego. Pacientes: incluimos 64 mujeres ASA I y II, con embarazo a término, sin indicación quirúrgica ni contraindicación para analgesia regional. Intervenciones: analgesia peridural con 10 ml de: Grupo I Bupivacaína 0.25 por ciento mas fentanil 50 ig. Grupo 2 Bupivacaína 0,25 por ciento mas tramadol 50 mg. Mediciones: respuesta al dolor con escala visual análoga (EVA),latencia y duración de la analgesia, bienestar materno (FC, TA, FR) y fetal (FCF, Apgar), evolución del trabajo de parto, efectos colaterales importantes y complicaciones. Conclusiones: los resultados de este ensayo clínico confirman la seguridad y la utilidad de la analgesia peridural en obstetricia, usando un anestésico local mas opioide. El tramadol demostró ser una alternativa adecuada (quizá mejor que el fentanil) por su efectividad y ausencia de efectos adversos relevantes

Efectos del tramadol sobre la respiración y el metabolismo basal / Effects of the tramadol on the breathing and the metabolism basal

Estudiamos la acción del Tramadol (un potente analgésico), en ratones, sobre el centro respiratorio y el metabolismo; como parámetros tomamos el volumen respiratorio minuto y el metabolismo basal. Encontramos que las variaciones de ambos parámetros guardan estrecha relación y tanto el volumen minuto respiratorio como el metabolismo basal se incrementan significativamente por acción de Tramadol.

We have studied the action of Tramadol (a potent anagesic) over the respiratory center and the metabolism in rats. We used the minute respiratory volume and the metabolic rate as parameters of our study. We found that variations in both parameters had close relationship. The minute respiratory volume and the metabolic rate got a significant increase by the action of Tramadol.