Tramadol Use in Perioperative Care and Current Controversies

Ogbemudia, Blessing; Qu, Ge; Henson, Chris; Esfandiary, Lida; Przkora, René; Victor, Sandra J.

doi:10.1007/s11916-022-01021-1

Cited by 8 publications

(7 citation statements)

References 21 publications

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“…Tramadol is an inhibitor of serotonin and norepinephrine reuptake and has a μ-receptor excitatory effect (Grond and Sablotzki, 2004;Ogbemudia et al, 2022). One study had performed painful stimulation of the nasal mucosa of 18 healthy volunteers and found that the analgesic effect produced by oral tramadol at night was stronger (Hummel et al, 1995); in contrast to this study, we explored the role of daytime variation in the analgesic effect of intravenous tramadol, and the results showed that it was stronger in the morning, than in the afternoon.…”

Section: Morning Afternoon Pmentioning

confidence: 71%

Role of daytime variation in pharmaceutical effects of sufentanil, dezocine, and tramadol: A matched observational study

et al. 2022

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The role of daytime variation in the comprehensive pharmaceutical effects of commonly used opioid analgesics in clinical setting remains unclear. This study aimed to explore the differences in daytime variation among elective surgery patients who were scheduled to receive preemptive analgesia with equivalent doses of sufentanil, dezocine, and tramadol in the morning and afternoon. The analgesic effect was assessed by changes in the pressure pain threshold before and after intravenous administration of sufentanil, dezocine, and tramadol. Respiratory effects were evaluated using pulse oximetry, electrical impedance tomography, and arterial blood gas analysis. Other side effects, including nausea, sedation, and dizziness, were also recorded, and blood concentration was measured. The results showed that the analgesic effects of sufentanil, dezocine, and tramadol were significantly better in the morning than in afternoon. In the afternoon, sufentanil had a stronger sedative effect, whereas dezocine had a stronger inhibitory respiratory effect. The incidence of nausea was higher in the morning with tramadol. Additionally, significant differences in different side effects were observed among three opioids. Our results suggest that the clinical use of these three opioids necessitates the formulation of individualized treatment plans, accounting for different administration times, to achieve maximum analgesic effect with minimal side effects.

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Section: Morning Afternoon Pmentioning

confidence: 71%

Role of daytime variation in pharmaceutical effects of sufentanil, dezocine, and tramadol: A matched observational study

et al. 2022

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“…Because tramadol was associated with fewer intravenous opioid boluses, it served as an effective alternative to strong opioids for postoperative pain. Tramadol is considered safer than common opioids as it has fewer and less severe side effects as well as being significantly less addictive 13–15. Notably, tramadol metabolism is affected by CYP2D6 polymorphism, but given the low prevalence of ultra-rapid metabolizers in the general population, the study did not evaluate this attribute 16.…”

Section: Discussionmentioning

confidence: 99%

Surgical opioid-avoidance protocol: a postoperative pharmacological multimodal analgesic intervention in diverse patient populations

Votta-Velis¹,

Daviglus

Borgeat³

et al. 2023

Reg Anesth Pain Med

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IntroductionThis study evaluated the effect of a surgical opioid-avoidance protocol (SOAP) on postoperative pain scores. The primary goal was to demonstrate that the SOAP was as effective as the pre-existing non-SOAP (without opioid restriction) protocol by measuring postoperative pain in a diverse, opioid-naive patient population undergoing inpatient surgery across multiple surgical services.MethodsThis prospective cohort study was divided into SOAP and non-SOAP groups based on surgery date. The non-SOAP group had no opioid restrictions (n=382), while the SOAP group (n=449) used a rigorous, opioid-avoidance order set with patient and staff education regarding multimodal analgesia. A non-inferiority analysis assessed the SOAP impact on postoperative pain scores.ResultsPostoperative pain scores in the SOAP group compared with the non-SOAP group were non-inferior (95% CI: −0.58, 0.10; non-inferiority margin=−1). The SOAP group consumed fewer postoperative opioids (median=0.67 (IQR=15) vs 8.17 morphine milliequivalents (MMEs) (IQR=40.33); p<0.01) and had fewer discharge prescription opioids (median=0 (IQR=60) vs 86.4 MMEs (IQR=140.4); p<0.01).DiscussionThe SOAP was as effective as the non-SOAP group in postoperative pain scores across a diverse patient population and associated with lower postoperative opioid consumption and discharge prescription opioids.

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“…The equivalent total prescription MME of tramadol and codeine given to operative patients is consistent with their rough equivalence in potency, while the disparity in total prescription MME given to nonoperative patients is not. This may be due to the perception of tramadol as a non-opioid or semi-opioid, resulting in tramadol being prescribed more liberally for subacute or chronic conditions or in patients who report opioid allergy or intolerance, although tramadol itself may cause nausea, drowsiness, and constipation frequently seen in patients with opioid intolerance [ 1 ]. The perception of tramadol as a non-opioid or semi-opioid may also factor into the preferential choice for prescribing this medication when there may be an expectation of a longer duration of treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the ongoing opioid crisis in the United States, opioids continue to remain a mainstay of perioperative and nonoperative pain management [ 1 ]. While not an opioid, tramadol is converted in the body to an active metabolite with Mu opioid receptor affinity, and thus, has opioid-like adverse effects, notably respiratory depression and dependence [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Tramadol Versus Codeine in Hand Surgery

Tulipan¹,

Abboudi²,

Wang³

et al. 2022

Cureus

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Introduction Tramadol and codeine are both commonly prescribed in the setting of surgery or injury to the upper extremity. Despite their comparable strength in terms of opioid receptor affinity, the drugs differ pharmacologically and thus are not completely interchangeable. Methods This study analyzes all prescriptions for codeine and tramadol by a group of hand surgeons over a one-year period and tests the central hypothesis that the prescribing and refill patterns of these two drugs would be similar. Results Despite similar prescription amounts in terms of morphine equivalents, patients receiving tramadol required prescription refills at a significantly higher amount than those receiving codeine, and these individuals tended to be older. Additionally, patients treated nonoperatively were prescribed significantly more tramadol than those treated surgically. Conclusion Our findings suggest that codeine and tramadol are not equivalent in managing upper extremity pain. Further study is needed to articulate the situations in which physicians and patients are better served by tramadol versus codeine.

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Tramadol Use in Perioperative Care and Current Controversies

Cited by 8 publications

References 21 publications

Role of daytime variation in pharmaceutical effects of sufentanil, dezocine, and tramadol: A matched observational study

Role of daytime variation in pharmaceutical effects of sufentanil, dezocine, and tramadol: A matched observational study

Surgical opioid-avoidance protocol: a postoperative pharmacological multimodal analgesic intervention in diverse patient populations

Tramadol Versus Codeine in Hand Surgery

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