This pilot study found that epidural tramadol administered before incision induced a Cmax within 30 minutes of administration. The drug was detected in serum at ∼21 hours after surgery.

Background Thromboembolism (TE) is a well-known complication during chemotherapy in cancer patients. However, the risk of TE associated with immune checkpoint inhibitors (ICIs) is unknown. This study was performed to investigate the incidence of TE and associated risk factors in patients treated with ICIs.Methods We conducted a retrospective chart survey of patients receiving at least one ICI at Shinshu University Hospital between September 2014 and October 2021. Age, sex, cancer type, body mass index, medical history, laboratory data at commencement of treatment, and medication data were obtained from electronic medical records. TE events (venous thromboembolism [VTE], arterial thromboembolism [ATE]) were identified after ICI initiation.Results The study population consisted of 550 patients with a median age of 70.0 (19–89) years, 71.3% men, and a median follow-up of 15.1 months (range; 0.16–72.0 months). Nivolumab was the most commonly used ICI (45.8%), followed by pembrolizumab (24.0%), pembrolizumab plus anticancer drugs (7.8%), and nivolumab plus ipilimumab (5.1%). Forty cases of TE (7.3%) occurred (22 VTE, 16 ATE). Risk factors significantly associated with TE in multivariate logistic analysis were urothelial cancers (OR 2.86; 95%CI, 1.13–7.21; p = 0.026), dyslipidemia (OR 2.33; 95%CI, 1.13–4.81; p = 0.023), Khorana score ≥ 2 (HR 2.22; 95%CI, 1.07–4.61; p = 0.032). Overall survival was not significantly different from patients without TE (p = 0.886).Conclusion These results suggested that the frequency of TE is higher than expected and should be considered and monitored in patients treated with ICIs.