The effects of different doses of tramadol on analgesia and electroencephalographic (EEG) spectral parameters were compared in rats. Saline or tramadol 5, 10, 20 or 40 mg/kg was administered. The degree of analgesia was evaluated by tail-flick latency, and the degree of seizure was measured using numerical seizure score (NSS). Additionally, band powers, median power frequency and spectral edge frequency 95 were measured to quantify the EEG response. All doses of tramadol produced spike-wave discharge. Tramadol significantly and dose-dependently increased the analgesia, but these effects did not correspond with the changes in the EEG spectral parameters. NSS significantly increased in the Tramadol 20 and 40 mg/kg treatment groups compared to the Control and TRA5 groups, and two rats given 40 mg/kg had convulsions. In conclusion, tramadol dose-dependently increased the analgesic effect, and the 10 mg/kg dose appears to be a reliable clinical dose for analgesia in rats, but dose-dependent increases in analgesia and seizure severity did not correlate with EEG spectral parameters.
Analgesia ; Animals ; Electroencephalography ; Rats ; Seizures ; Tramadol

BACKGROUND: We wanted to determine the postoperative analgesic efficacy of preincisional caudal epidural block versus instillation (splash block) following inguinal herniorrhaphy in children. METHODS: Thirty children (age range: 1-7 years) who were scheduled to undergo inguinal herniorrhaphy were divided into 2 groups: the caudal block group and the splash block group with 15 children in each group. Tracheal intubation was performed. Fifteen children received caudal block with 1.0 ml/kg of 0.25% ropivacaine (Group 1). Caudal block was performed using the loss of resistance method via the sacral hiatus. Fifteen children in Group 2 received local instillation (splash block) in the surgical site with up to 0.4 ml/kg of 0.25% ropivacaine. The patients were observed for 90 minutes in the postanesthesia care unit and then they were transferred to the ward. The pain scores were taken 4 times. We assessed pain using the Faces pain scores. RESULTS: There were no significant differences between the groups regarding the pain scores at 10, 30 and 60 minutes upon entering the postanesthesia care unit. The pain scores of Group 1 were slightly lower at the last evaluation point when compared to that of Group 2. One patient in Group 1 required supplemental postoperative intravenous (IV) tramadol, while all the other patients in both groups did not require supplemental IV tramadol. The intraoperative requirement for sevoflurane was decreased in Group 1 as compared to that of Group 2. There were no major complications related to either type of block. CONCLUSIONS: We conclude that a splash block can have a similar analgesic effect as that of a caudal block for the postoperative herniorrhaphy pain of children.
Amides ; Analgesia ; Child ; Herniorrhaphy ; Humans ; Intubation ; Methyl Ethers ; Tramadol

BACKGROUND: Tramadol is a centrally acting analgesic with weak opioid agonist properties and has effect on the spinal inhibition of pain. This study was designed to evaluate the efficacy of tramadol in the treatment of postanesthetic shivering. METHODS: Sixty patients (ASA class I/II) who showed postanesthetic shivering were randomly assigned into three groups (n=20): Normal saline group; normal saline 10 ml, tramadol (TRD) 0.5 mg/kg group; tramadol 0.5 mg/kg, TRD 1.0 mg/kg group; tramadol 1.0 mg/kg. And all patients received standard postoperative management in the recovery room. Evaluation of the grade of shivering was done at 30 seconds, 2, 5 and 10 minutes from the beginning of the treatment by the same investigator who had injected the drug. The age, sex, weight, duration of anesthesia and axillary temperature were recorded. RESULTS: By 30 seconds, 2 minutes, 5 minutes, and 10 minutes, 0, 4, 9, 9 patients of the 0.5 mg/kg tramadol group (n=20) and 7, 18, 19, 19 patients of the 1.0 mg/kg tramadol group (n=20) stopped the shivering respectively. But in 3 patients of 0.5 mg/kg tramadol group who stopped shivering by 5 minutes, shivering was recurred within 10 minutes and in 3 patients who had not stopped shivering by 5 minutes, shivering stopped by 10 minutes. In the placebo group, only 1 patient stopped shivering by 5 minutes. CONCLUSION: 1.0 mg/kg of tramadol was effective for the treatment of postanesthetic shivering but 0.5 mg/kg of tramadol was ineffective.
Anesthesia ; Humans ; Recovery Room ; Research Personnel ; Shivering* ; Tramadol*

BACKGROUND: Tramadol is a centrally acting analgesic with weak opioid agonist properties and has effect on the spinal inhibition of pain. This study was designed to evaluate the efficacy of tramadol in the treatment of postanesthetic shivering. METHODS: Sixty patients (ASA class I/II) who showed postanesthetic shivering were randomly assigned into three groups (n=20): Normal saline group; normal saline 10 ml, tramadol (TRD) 0.5 mg/kg group; tramadol 0.5 mg/kg, TRD 1.0 mg/kg group; tramadol 1.0 mg/kg. And all patients received standard postoperative management in the recovery room. Evaluation of the grade of shivering was done at 30 seconds, 2, 5 and 10 minutes from the beginning of the treatment by the same investigator who had injected the drug. The age, sex, weight, duration of anesthesia and axillary temperature were recorded. RESULTS: By 30 seconds, 2 minutes, 5 minutes, and 10 minutes, 0, 4, 9, 9 patients of the 0.5 mg/kg tramadol group (n=20) and 7, 18, 19, 19 patients of the 1.0 mg/kg tramadol group (n=20) stopped the shivering respectively. But in 3 patients of 0.5 mg/kg tramadol group who stopped shivering by 5 minutes, shivering was recurred within 10 minutes and in 3 patients who had not stopped shivering by 5 minutes, shivering stopped by 10 minutes. In the placebo group, only 1 patient stopped shivering by 5 minutes. CONCLUSION: 1.0 mg/kg of tramadol was effective for the treatment of postanesthetic shivering but 0.5 mg/kg of tramadol was ineffective.
Anesthesia ; Humans ; Recovery Room ; Research Personnel ; Shivering* ; Tramadol*

STUDY DESIGN: A single center, double-blind, randomized, placebo-controlled trial. OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of Ultracet(TM) compared with a placebo in the treatment of acute pain after spinal surgery. SUMMARY OF LITERATURE REVIEW: Ultracet(TM) is a combination drug of Tramadol and Acetaminophen, and the synergistic effect in pain control was demonstrated by animal experiments. MATERIALS AND METHODS: Seventy-six patients who satisfied the selection and exclusion criteria after spinal surgery were enrolled in this study. The patients measured perceptible pain relief time and meaningful pain relief time using a two stopwatch technique. The pain intensity (PI) and pain relief (PAR) were recorded at 30 minutes and then hourly over a 4 hour period, and the pain intensity difference (PID), the sum of the pain intensity difference (SPID), and the total pain relief (TOPAR) were also checked. RESULTS: The study and control group comprised of 56 and 20 patients, respectively. The baseline pain intensity was an average of 5.9+/-1.2 in the study group and 6.1+/-1.4 in the control group (p=0.683). The final pain intensity was 2.5+/-2.4 and 4.1+/-2.2 in the study and control group, respectively. The study group was superior to placebo (p=0.008). In addition, the study group was statistically superior in terms of the PID (p=0.025), SPID (p=0.028), and TOPAR (p=0.048), particularly over 2 hours, as well as the overall assessment (p=0.005). The median time of the meaningful pain relief time was 90 and 193 minutes in the study and control group, respectively. CONCLUSIONS: The analgesic efficacy of Ultracet(TM) was superior to the placebo on the SPID, TOPAR, and the subjects' overall assessments over the 4 hour observation period. These results suggest that Ultracet(TM) is an effective therapeutic option for the management of acute pain after spinal surgery without serious complications.
Acetaminophen ; Acute Pain* ; Animal Experimentation ; Humans ; Spinal Diseases ; Tramadol

This is a systematic review and meta-analysis on the efficacy of ondemand tramadol for the treatment of lifelong premature ejaculation.

METHODS: A systematic review and meta-analysis with metaregression of trials evaluating the use of tramadol to treat premature ejaculation using intravaginal ejaculation latency time as a measure.Relevant studies were identified using PubMed, Ebscohost,MEDLINE, EMBASE and the Cochrane Collaboration Library.

RESULTS: This analysis included 8 publications. Study of the intravaginal ejaculation latency time (IELT) among 599 patients showed that tramadol was effective in subjects with premature ejaculation as seen by the significant difference in mean IELT of tramadol treated patients versus those receiving placebo (mean difference 2.43 minutes; 95% CI 0.93-3.93; P=0.002). The effect on IELT between tramadol and paroxetine was not statistically significant (mean difference -0.58; 95% CI -5.81 to 4.65; P=0.83).Meta-regression analysis showed that the lower the dose of tramadol,the higher its benefit in the prolongation of IELT, however, there was no significant difference (95% CI regression coefficient -0.0956 to 0.0322). There was a significant difference in adverse effects profile of tramadol versus placebo (risk ratio 2.48; 95% CI 1.55-3.98; overall effect Z= 3.79; P<0.0002) and overall therapeutic effectiveness between tramadol compared to placebo (risk ratio 0.55; 95% CI 0.46-0.67; P<0.00001).

CONCLUSION: On-demand tramadol is an effective treatment for lifelong premature ejaculation. It significantly prolongs the intravaginal ejaculation latency time. The overall adverse events and overall therapeutic effectiveness are significantly greater during treatment with tramadol.

Tramadol can increase the serum level of serotonin, causing serotonin syndrome, which is a potentially life-threatening condition. Serotonin syndrome occurs when tramadol is used in combination with other drugs that affect serotonin. A patient who had been taking selective serotonin reuptake inhibitor and stopped at 10 days before surgery experienced intermittent heart rate elevation, tremor of the upper extremities and mental change after receiving an infusion of tramadol for postoperative pain control. Although he did not show the typical triad of serotonin syndrome (systemic autonomic dysfunction, neuromuscular impairment and mental status change), the patient was suspected to have serotonin syndrome caused by tramadol.
Heart Rate ; Humans ; Pain, Postoperative ; Serotonin Syndrome* ; Serotonin Uptake Inhibitors ; Serotonin* ; Tramadol ; Tremor ; Upper Extremity

To confirm the effects of atropine and neostigmine on heart rate in balanced anesthesia with tramadol (Tridol) two groups of patients who were included in class I by A.S.A. classification were studied. In group I, only atropine(1.0 mg) was given to 8 patients at the end of operation. Group 2, a mixture of atropine(1. 0 mg) and neostigmine (2.0 mg) was given to 16 patients under the same condition as group 1. The heart rate was checked every 15 seconds for 10 minntes in each group. The results were as followes:1) In group 1, about 16% increase in heart rate was manifested at 11/4 minutes after injection. After that the was no significant change in heart rate. 2) In group 2, about 19% increase in heart rate was observed at 1 minute after injection. After that 28% decrease in heart rate was noted 6 minutes after injection. After that there was no significant change in heart rate. 3) There was no significant difference between the two groups at 1 minute after injection. 4) When a mixture of atropine and neostigmine was given, atropine effect appeared earlier than neostigmine. Therefore if a mixture of atropine and neostigmine is used, we don't need to inject it very slowly in anticipation of bradycardia.5) Even though the IV route is uncertain, neostigmine triggered bradycardia can be controlled by using it mixed with atropine. because shortly after infection of the mixture no bradycardia occurs, the operator has sufficient time to correct it should it be set in later.
Atropine* ; Balanced Anesthesia ; Bradycardia ; Classification ; Heart Rate* ; Heart* ; Humans ; Neostigmine* ; Tramadol

BACKGROUND: The saddle block with heavy bupivacaine is confinal to the lower lumbar and sacral dermatomes. We reduced the infusion dose of bupivacaine to confine the blocked area to the perineum, and evaluated intrathecal bupivacaine with intrathecal bupivacaine and tramadol or clonidine for their anesthetic and analgesic effect in patients undergoing hemorrhoidectomy. METHODS: Sixty patients (ASA I - II, aged 20 to 55) scheduled for hemorrhoidectomy were divided into three groups. We gave a 0.2 ml placebo (0.9% normal saline) in the control group (n = 20), 0.2 ml tramadol (10 mg) in the tramadol group, and 0.2 ml clonidine (50 microgram) in the clonidine group (n = 20) intrathecally 1 minute after saddle block with 0.5% heavy bupivacaine 2 mg. We compared the effects of the sensory and motor blocks by using the analgesic time and the degree of anal relaxation and the side effects. RESULTS: The analgesic time was greater in the tramadol group than is the control group (P < 0.05), and in the clonidine group if was group then in the tramadol group (P < 0.05) and the control group (P< 0.01). Anal relaxation for hemorrhoidectomy in the tramadol group and the clonidine group was better than that of the control group. The incidence of paresthesia of the foot in the clonidine group (n = 16) was higher than in tramadol group (n = 3) and the control group (n = 1) (P < 0.01). The incidence of patients with urinary retention was significantly lower in the control group than in the tramadol group (n = 3) and the clonidine group (n = 4). CONCLUSIONS: Both bupivacaine 2 mg with tramadol and clonidine were efficient in hemorhoidectomy provided good conditions for hemorhoidectomy.
Bupivacaine* ; Clonidine* ; Foot ; Hemorrhoidectomy ; Humans ; Incidence ; Paresthesia ; Perineum ; Relaxation ; Tramadol* ; Urinary Retention

BACKGROUND: The saddle block with heavy bupivacaine is confinal to the lower lumbar and sacral dermatomes. We reduced the infusion dose of bupivacaine to confine the blocked area to the perineum, and evaluated intrathecal bupivacaine with intrathecal bupivacaine and tramadol or clonidine for their anesthetic and analgesic effect in patients undergoing hemorrhoidectomy. METHODS: Sixty patients (ASA I - II, aged 20 to 55) scheduled for hemorrhoidectomy were divided into three groups. We gave a 0.2 ml placebo (0.9% normal saline) in the control group (n = 20), 0.2 ml tramadol (10 mg) in the tramadol group, and 0.2 ml clonidine (50 microgram) in the clonidine group (n = 20) intrathecally 1 minute after saddle block with 0.5% heavy bupivacaine 2 mg. We compared the effects of the sensory and motor blocks by using the analgesic time and the degree of anal relaxation and the side effects. RESULTS: The analgesic time was greater in the tramadol group than is the control group (P < 0.05), and in the clonidine group if was group then in the tramadol group (P < 0.05) and the control group (P< 0.01). Anal relaxation for hemorrhoidectomy in the tramadol group and the clonidine group was better than that of the control group. The incidence of paresthesia of the foot in the clonidine group (n = 16) was higher than in tramadol group (n = 3) and the control group (n = 1) (P < 0.01). The incidence of patients with urinary retention was significantly lower in the control group than in the tramadol group (n = 3) and the clonidine group (n = 4). CONCLUSIONS: Both bupivacaine 2 mg with tramadol and clonidine were efficient in hemorhoidectomy provided good conditions for hemorhoidectomy.
Bupivacaine* ; Clonidine* ; Foot ; Hemorrhoidectomy ; Humans ; Incidence ; Paresthesia ; Perineum ; Relaxation ; Tramadol* ; Urinary Retention