Tramadol in acute postoperative pain
Tramadol was first introduced into the German market by its developer Grünenthal GmbH in the mid-1970s and it has proven effective in pain management without the side-effects of depressed heart and breathing action. Further, the fact that Tramadol has no history in substance abuse has meant that it has never been included in the list of controlled drugs. It therefore very quickly became the most popular analgesic of its class in Germany. Although Tramadol has been used in infarction and other heart emergencies, in accident and trauma centers and for the relief of perinatal pain, most studies have focused on the postoperative context. Clinical experience with Tramadol shows that it provides effective analgesia after both oral and intramuscular/intravenous administration. The evidence shows the effects of Tramadol as favourably comparable to those of Demerol and morphine. This success is, however, limited to the postoperative context and should not be taken to imply that Tramadol can be used in conjunction with a general anaesthesia. Tramadol does not have a sedative.
| In one randomised double-blind study, researchers reported that acceptable analgesia was achieved with intravenous Tramadol at a dosage of 50mg, repeated once if required after 30 minutes. It produced an effect similar to that of 5mg morphine and 150mg Clonidine. In a second study, it was shown that the 50mg dose of Tramadol satisfied the patients' need for an analgesic for the relief of moderate pain. In all cases of more severe pain, a higher dose is indicated. |
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Most patients take Tramadol without experiencing any significant side-effects. The side-effects most commonly experienced are nausea and vomiting. Unlike morphine and pethidine, there is rarely any effect on breathing at similar dosages, and it is does not generally affect heart function or cause dizziness and drowsiness. Finally, there are fewer problems of abuse and dependence. Hence, Tramadol has been adopted for the first-line management of postoperative pain instead of morphine. In a straight comparison, Tramadol is reported as more effective than NSAIDs, but the best result are obtained when Tramadol is used in combination with NSAIDs because that allows the Tramadol dose to be reduced and results in a lower incidence of adverse side-effects.
Patient-controlled analgesia (PCA) is frequently allowed with Tramadol. The extent to which any patient experiences pain and so requires an analgesic is based on a highly subjective process. The best clinical practice now accepts that the achievement of adequate pain management requires the therapy to be individualised by pacing the titration of the analgesic to actual patient's needs. This means that the demand for medication and the dosage delivered are decisive in satisfying the patient's need for pain control and his or her acceptance of PCA. Patients rarely overmedicate themselves and need rescue, but this can happen when weaker opioids are used. Thus, Tramadol can be recommended as a basic analgesic for the treatment of moderate to severe pain. If Tramadol is not effective or reduces in effectiveness over time, more potent opioids may be used. There have been no research studies into the use of Tramadol after day-case surgery, but anecdotal evidence is that it is frequently administered with good results.
The most important side-effects of Tramadol are nausea and vomiting, which can often be prevented either by slow injection and the administration of an antiemetic.
