Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new ultram research articles will be listed here shortly after becoming available to us.
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Combined regional and general anesthesia for ambulatory peripheral orthopedic surgery in children.
J Pediatr Orthop B. 2008 Nov 17;
Khoury CE, Dagher C, Ghanem I, Naccache N, Jawish D, Yazbeck P
Pediatric orthopedic surgery is rarely done in an outpatient setting because of the postoperative pain. The purpose of this study was to evaluate the children's comfort and parents' satisfaction after ambulatory peripheral pediatric orthopedic surgery performed under general anesthesia combined with regional anesthesia (RA). Sixty consecutive children were enrolled in this prospective study. All children fulfilled inclusion criteria for outpatient and for RA and parents received proper information regarding their child postoperative care. Postoperative pain control was sustained for 48 h using routine paracetamol, ibuprofen, and oral tramadol if needed. A telephone survey was conducted on day 1 and day 2 to evaluate pain scores, limb motor function, occurrence of postoperative nausea and vomiting, and feeding, sleep or play disturbance. The parents were also asked about their overall satisfaction rate and the choice of ambulatory mode versus inpatient admission in case of future orthopedic procedure. A total of 34 soft tissue procedures and 26 bony procedures were performed. 63.3% recovered motor function before discharge from the postanesthesia care unit. Low pain scores and good postoperative comfort were observed. Parents' satisfaction was greater than eight out of 10 in 88.3% of the cases, and 85% of the parents would choose ambulatory surgery in case of a second procedure. RA used with level I or II analgesics is compatible with ambulatory peripheral pediatric orthopedic surgery. Resulting good analgesia and postoperative comfort render the ambulatory mode to be favored by the parents.
Intraarticular Tramadol or "Hot Chili Peppers"?
Anesth Analg. 2008 Dec; 107(6): 2092-2093
Tabboush Z
Tramadol Added to Bupivacaine Does Not Prolong Analgesia of Continuous Psoas Compartment Block.
Pain Pract. 2008 Sep 9;
Kumar M, Batra YK, Panda NB, Rajeev S, Nagi ON
blacksquare, square, filled Abstract: The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups (n = 15). Visual analog scale pain score was not significantly different between the groups during the 48-hour follow-up period. Rescue analgesic consumption, nausea and vomiting, and the satisfaction scores were comparable between the groups (P > 0.05). Success with catheter placement adjacent to the lumbar plexus was 100%, and none of the patients developed any catheter-related complications. In conclusion, tramadol does not provide a clinically significant analgesic action as an adjunct to 0.25% bupivacaine for CPCB. blacksquare, square, filled.
Benefits of Extended-Release Opioid Analgesic Formulations in the Treatment of Chronic Pain.
Pain Pract. 2008 Oct 27;
Nicholson B
Abstract Chronic noncancer pain represents a major health problem that affects many patients, resulting in suffering, reduced productivity, and substantial health care costs. The patient with chronic noncancer pain is burdened by decreased quality of life, decreased sleep, interference with social relationships, diminished cognitive functions, interference with activities of daily living, decreased productivity, and increased anxiety and depression. A survey examining the burden of pain on health and productivity found decreases of 45% in physical health and 23% in mental health at a cost of $61.2 billion per year in productive work time. An American Pain Society survey of 800 patients with moderate to severe chronic pain reported that 47% felt their pain was not under control. The goal of pharmacological therapy for chronic noncancer pain is to provide sustained analgesia. Chronic pain management guidelines recommend the use of long-acting, extended-release (ER) analgesics because they provide prolonged, more consistent plasma concentrations of drug compared with short-acting agents, thus minimizing fluctuations that could contribute to end-of-dose breakthrough pain. ER analgesics offer more consistent and improved nighttime pain control, less need to awaken at night to take another dose of pain medication, and less clock-watching by patients in chronic noncancer pain. Among the available ER opioids, tramadol ER possesses a unique mechanism of action, making it a viable opioid of first choice for patients suffering from a variety of chronic noncancer pain conditions, such as osteoarthritis, low back pain, and neuropathic pain.
Efficient assessment of neuropathic pain drugs in patients with small fiber sensory neuropathies.
Pain. 2008 Nov 13;
Ho TW, Backonja M, Ma J, Leibensperger H, Froman S, Polydefkis M
We sought to develop an enrichment crossover study design that would allow us to efficiently evaluate and compare promising candidate neuropathic pain drugs. We evaluated the efficacy of gabapentin or tramadol vs. active placebo (diphenhydramine) in subjects with biopsy-proven painful idiopathic small fiber neuropathy (SFN) who were self-reported gabapentin responders. Eligible subjects entered two single blind run-in phases. In the first phase (Period A), subjects were treated with single blinded gabapentin at their prestudy dose followed by a second run-in phase (Period B) in which they were treated with diphenhydramine active placebo. Subjects with 3 pain and a 30% increase in pain intensity in Period B compared to Period A were then randomized to a double-blind three period cross over trial of gabapentin at pre study dosage, tramadol 50mg QID and diphenhydramine 50mgqhs. Of the 59 subjects enrolled, 41 subjects were excluded: Twenty-three had an insufficient rise in pain intensity in Period B; eight had skin biopsies that did not confirm SFN. Eighteen subjects were randomized into the double-blind, crossover phase. There was a significant treatment effect of gabapentin vs. diphenhydramine (p=0.001) and tramadol vs. diphenhydramine (p=0.018) by the before-bed daily pain score averaged over the final 7 days of each treatment period. We conclude that gabapentin and tramadol were effective in the treatment of painful SFN and that this experimental enrichment paradigm is attractive to screen potential neuropathic pain compounds for efficacy in proof-of-concept studies.
Effect of tramadol on immune responses and nociceptive thresholds in a rat model of incisional pain.
J Zhejiang Univ Sci B. 2008 Nov; 9(11): 895-902
Liu YM, Zhu SM, Wang KR, Feng ZY, Chen QL
Objective: To evaluate the effects of tramadol on the proinflammatory responses in a rat model of incisional pain by investigating its effects on nociceptive thresholds and serum interleukin-6 (IL-6) and IL-2 levels. Methods: Forty-two male Sprague-Dawley (SD) rats scheduled for plantar incision were randomly divided into 7 groups (n=6 in each group). Rats in Group 1 receiving general anesthesia with no incision were served as control; At 30 min before skin incision, Groups 2~5 were given 5 ml normal saline or 1, 10, and 20 mg/kg tramadol, respectively, intraperitoneally (i.p.); Group 6 received 10 mg/kg tramadol after operation; Group 7 received 10 mg/kg tramadol before incision, followed by 200 mug/kg naloxone after operation. Mechanical allodynia was measured by electronic von Frey filament to evaluate the nociceptive thresholds 1 h before incision, and 1 h and 2 h after operation. Serum IL-6 and IL-2 levels were measured by enzyme-linked immunosorbent assay (ELISA) 2 h after operation. Results: Mechanical thresholds decreased significantly and serum IL-6 level increased significantly after operation in Group 2 compared with control (P
Neuro Endocrinol Lett. 2008 Oct 11; 29(5): 749-754
Maresova V, Chadt J, Novakova E
OBJECTIVES: The purpose of this study is to develop the gas chromatographicmass spectrometric method (GC-MS) for screening and semiquantification of drugs and drugs of abuse in human serum. METHOD: GC-MS method after liquid-liquid extraction (LLE) and derivatization with N-methyl-Ntrimethylsilyltrifluoroacetamide (MSTFA) is presented for screening as well as identification and semiquantification of the most frequently used drugs and drugs of abuse in human serum. RESULTS: Bovine serum spiked with ephedrine (EPHE), 3,4-methylenedioxymethamphetamine (MDMA), guaifenesin (GUAIF), tramadol (TRAM), phenobarbital (PHENO), amitriptyline (AMITR), cocaine (COCA), mirtazapine (MIRTA), dothiepin (DOTH), citalopram (CITAL), clomipramine (CLOMI), bromazepam (BMZPM), diazepam (DZPM), codeine (COD), morphine (MORPH), levomepromazine (LEVO), zolpidem (ZOLP), clozapine (CLOZP), alprazolam (ALPZM) was used for the recovery and repeatability study and for preparation of calibration curves of individual compounds or their TMS derivatives. Recoveries were tested on concentration levels 0.05, 0.1 and 0.5 mug/mL (n=6) and established in range 72.0-98.0%. Repeatabilities expressed as relative standard deviations (RSDs) measured at concentration levels 0.05, 0.1 and 0.5 mug/ mL (n=6) were lower than 10.0%. The calibration curves for analytes or their TMS derivatives were linear in concentration range 0.025-2.000 mug/mL (except EPHE 2TMS, MDMA TMS, MORPH 2TMS, BMZPM TMS, ALPZM) with correlation coefficients exceeding 0.99. The limit of quantification (LOQ) for analytes used for evaluation study was 0.025 mug/mL (except analytes mentioned above). CONCLUSIONS: The GC-MS method presented here is allowing screening, identification and semiquantification of the most commonly encountered drugs and drugs of abuse in human serum and can be successfully applied to analysis of real samples from clinical and forensic toxicology cases.
Prescribing of pain medication in palliative care. A survey in general practice.
Pharmacoepidemiol Drug Saf. 2008 Nov 4;
Borgsteede SD, Deliens L, Zuurmond WW, Schellevis FG, Willems DL, Van der Wal G, van Eijk JT
PURPOSE: To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands. METHODS: In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1-year study period. We analysed the analgesics, laxatives and anti-emetics that were prescribed during the last 3 months of life for these patients. RESULTS: The response rate of the survey was 74%. 425 patients received palliative care and 73% of them were prescribed pain medication: 55% a non-opioid analgesic (paracetamol, NSAIDs), 21% a weak opioid (tramadol, codeine), and 51% a strong opioid. Relatively more younger than older patients were prescribed strong opioids, and more cancer than non-cancer patients were prescribed an analgesic. During the last 3 months of life, the proportion of patients prescribed a non-opioid or a weak opioid increased gradually. The proportion of patients prescribed a strong opioid increased considerably nearing the patient's death. About one third of the non-cancer patients were prescribed strong opioids, mostly commencing in the last 2 weeks before death. In 48% of all patients with an opioid prescription, the GP did not prescribe a laxative. CONCLUSIONS: Weak opioids and laxatives are frequently omitted from pain regimens in palliative care at home in The Netherlands. Copyright (c) 2008 John Wiley & Sons, Ltd.
Arch Orthop Trauma Surg. 2008 Nov 4;
Ayoglu H, Altunkaya H, Bayar A, Turan IO, Ozer Y, Ege A
INTRODUCTION: The purpose of this prospective randomized study was to evaluate the effects of intraarticular combinations of tramadol and ropivacaine with ketamine in postoperative pain control of patients undergoing arthroscopic meniscectomy. MATERIALS AND METHODS: We randomly divided 80 patients into four groups to receive intraarticular 50 mg tramadol (Group T), 50 mg tramadol with 0.5 mg kg(-1) ketamine (Group TK), 75 mg ropivacaine (Group R), 75 mg ropivacaine with 0.5 mg kg(-1) ketamine (Group RK) in 20 ml normal saline at the end of surgery. Postoperative analgesia was provided with patient-controlled analgesia with morphine. Postoperative pain scores, total morphine consumption amount and side effects were recorded at intervals of 0, 1, 2, 4, 8, 12 and 24 h after the operation. RESULTS: Pain scores were higher in Group T when compared with Group R and Group RK at second and fourth hours, also compared with Group RK at zeroth, first, second, fourth and eighth hours. Total morphine consumption amount was found to be higher in Group T when compared to Group TK at eighth and twelfth hours and Group RK at eighth hours (P < 0.05). Total morphine consumption was lowest in Group TK (P < 0.05). There were no significant differences among the study groups regarding side effects. CONCLUSIONS: Administration of intraarticular tramadol-ketamine combination was found to be more effective in decreasing postoperative daily analgesic consumption.
Hypertrophic osteodystrophy of the proximal humerus in two dogs.
J Am Anim Hosp Assoc. 2008 Nov-Dec; 44(6): 342-6
Franklin MA, Rochat MC, Broaddus KD
Two dogs, 3 and 6 months of age, were presented with painful, swollen shoulder and carpal joints; reluctance to stand; and pyrexia. Radiographs in both cases revealed an irregular lucent zone in the metaphysis of the proximal humerus, parallel and adjacent to the physis. The same lucent zone was also evident in the physes of the distal radial and ulnar metaphyses. Clinical signs and radiographs were consistent with hypertrophic osteodystrophy. Clinical signs resolved in both dogs with administration of carprofen, tramadol, and intravenous fluids. No signs of recurrence were reported at 3-month follow-ups.