Tramadol : a review of its use
in perioperative pain

by
Scott LJ, Perry CM
Adis International Limited,
Auckland, New Zealand.
demail@adis.co.nz
Drugs 2000 Jul; 60(1):139-76


ABSTRACT

Tramadol is a synthetic, centrally acting analgesic agent with 2 distinct, synergistic mechanisms of action, acting as both a weak opioid agonist and an inhibitor of monoamine neurotransmitter reuptake. The 2 enantiomers of racemic tramadol function in a complementary manner to enhance the analgesic efficacy and improve the tolerability profile of tramadol. In several comparative, well designed studies, oral and parenteral tramadol effectively relieved moderate to severe postoperative pain associated with surgery. Its overall analgesic efficacy was similar to that of morphine or alfentanil and superior to that of pentazocine. Tramadol provided effective analgesia in children and in adults for both inpatient and day surgery. Tramadol was generally well tolerated in clinical trials. The most common adverse events (incidence of 1.6 to 6.1%) were nausea, dizziness, drowsiness, sweating, vomiting and dry mouth. Importantly, unlike other opioids, tramadol has no clinically relevant effects on respiratory or cardiovascular parameters at recommended doses in adults or children. Tramadol also has a low potential for abuse or dependence. CONCLUSIONS: The efficacy of tramadol for the management of moderate to severe postoperative pain has been demonstrated in both inpatients and day surgery patients. Most importantly, unlike other opioids, tramadol has no clinically relevant effects on respiratory or cardiovascular parameters. Tramadol may prove particularly useful in patients with poor cardiopulmonary function, including the elderly, the obese and smokers, in patients with impaired hepatic or renal function, and in patients in whom nonsteroidal anti-inflammatory drugs are not recommended or need to be used with caution. Parenteral or oral tramadol has proved to be an effective and well tolerated analgesic agent in the perioperative setting.
Dosage
Morphine
Fentanyl
Tolerance
Endomorphins
Buprenorphine
Opiate Timeline
Tramadol: structure
Tramadol and analgesia
Tramadol and acute pain
Tramadol as an antidepressant
Tramadol: risk/benefit analysis
Tramadol versus buprenorphine
Depression, opioids and the HPA
Sustained release tramadol capsules
Pharmacokinetics and pharmacodynamics
Morphine: a mood-brightening smart-drug?
Tramadol, depression and Parkinson's disease


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