• Despoina Kakagia, Theodosia Vogiatzaki, Savvas Eleftheriadis, Gregory Trypsiannis, and Christos Iatrou.
• Department of Plastic Surgery, Democritus University of Thrace, Alexandroupolis, Greece. despoinakakagia@yahoo.com
• J Cutan Med Surg. 2012 Mar 1;16(2):101-6.

BackgroundIn this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face.MethodsEighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n  =  46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n  =  42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded.ResultsThere were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p  =  .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p  =  .741 and p  =  .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p  =  .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours.ConclusionTramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.

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