The analgesic efficacy of intravenous versus oral tramadol for preventing postoperative pain after third molar surgery.

Abstract

PURPOSE:

The aim of this study was to compare the analgesic efficacy of single-dose preoperative intravenous versus oral tramadol for preventing pain after third molar surgery.

PATIENTS AND METHODS:

Seventy-two patients undergoing elective third molar surgery were randomized to receive either intravenous (n = 36) or oral (n = 36) tramadol 50 mg. The intravenous group received an oral placebo capsule followed by intravenous tramadol 50 mg preoperatively. The oral tramadol group received a 50-mg oral tramadol capsule followed by intravenous placebo saline preoperatively. In both groups, a standard intravenous sedation technique was administered and the impacted third molars were removed under local anesthesia. The difference in postoperative pain was assessed by 4 primary end points: hourly pain intensity as measured by a 100-mm visual analog scale for 8 hours, time to rescue analgesic, postoperative acetaminophen consumption, and a 5-point global assessment scale (0 = poor, 1 = fair, 2 = good, 3 = very good, and 4 = excellent).

RESULTS:

Throughout the 8-hour investigation period, patients reported significantly lower pain intensity scores in the intravenous versus oral group (15.9 +/- 9.6 mm versus 36.9 +/- 17.2 mm, P = .03). Patients also reported significantly longer time to rescue analgesic (7.0 hours versus 3.5 hours, P = .00001), lesser postoperative acetaminophen consumption (1,823 +/- 1,266 mg versus 3,558 +/- 1,418 mg, P = .000006), and better global assessment (2.6 +/- 0.9 versus 1.1 +/- 0.8, P = .01) for the intravenous versus oral group.

CONCLUSIONS:

We conclude that preoperative intravenous tramadol is superior to oral tramadol for preventing postoperative pain following third molar surgery. However, it should be noted that there is a difference in the bioavailability between the 2 formulations of up to 30%, which may explain the findings.

• Authors: Cliff K S Ong, Phillip Lirk, Juliana M H Tan, Belle W Y Sow
• Journal: Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (J Oral Maxillofac Surg) Vol. 63 Issue 8 Pg. 1162-8 (Aug 2005) ISSN: 0278-2391 [Print] United States
• PMID: 16094585 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Non-Narcotic
• Analgesics, Opioid
• Placebos
• Acetaminophen
• Tramadol

Topics

• Acetaminophen (therapeutic use)
• Administration, Oral
• Adult
• Analgesics, Non-Narcotic (therapeutic use)
• Analgesics, Opioid (administration & dosage)
• Anesthesia, Dental
• Anesthesia, Local
• Conscious Sedation
• Elective Surgical Procedures
• Female
• Follow-Up Studies
• Humans
• Injections, Intravenous
• Male
• Molar, Third (surgery)
• Pain Measurement
• Pain, Postoperative (prevention & control)
• Placebos
• Premedication
• Tooth Extraction (adverse effects)
• Tooth, Impacted (surgery)
• Tramadol (administration & dosage)