Pharmacol Rep
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Randomized Controlled Trial
Preoperative tramadol combined with postoperative small-dose tramadol infusion after total abdominal hysterectomy: a double-blind, randomized, controlled trial.
This double blind, randomized, controlled trial investigated whether a single preoperative intravenous (iv) dose of tramadol (100 mg) given 30 min before abdominal hysterectomy resulted in improved analgesic efficacy, reduced postoperative morphine patient-controlled analgesia (PCA) use and reduced side effects when combined with a postoperative small-dose tramadol infusion. Two-hundred twenty-four patients undergoing elective abdominal hysterectomy were randomly allocated to one of two groups: the tramadol group (n = 113) received iv tramadol (100 mg) 30 min before surgery, and the control group (n = 111) received an equivalent volume of normal saline. Upon awakening from general anesthesia, all patients received a loading dose of 0.5 mg/kg of tramadol and a small-dose infusion of tramadol (0.1 mg/kg/h) for 48 h. ⋯ Preemptive tramadol was associated with superior analgesia at rest and with movement in the first 24 h after surgery (p < 0.01), a longer interval to first morphine PCA request (p = 0.019), and reduced morphine PCA use (p = 0.017). The tramadol group had reduced nausea (p = 0.015), dizziness (p = 0.001) and drowsiness (p = 0.0001), while other side-effects were similar. In conclusion, a single dose of iv tramadol (100 mg) 30 min prior to abdominal hysterectomy improves analgesia, and reduces morphine PCA requirements, nausea, dizziness and drowsiness when combined with a postoperative small-dose tramadol infusion and morphine PCA when compared to the same analgesic regimen that omitted the preemptive tramadol.
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In most cancer patients, pain is successfully treated with pharmacological measures such as opioid analgesics alone or opioid analgesics combined with adjuvant analgesics (co-analgesics). Opioids for mild-to-moderate pain (formerly called weak opioids) are usually recommended in the treatment of cancer pain of moderate intensity. ⋯ Its unique mechanism of action, analgesic efficacy and profile of adverse effects are responsible for its successful use in patients with different types of acute and chronic pain, including neuropathic pain. The aim of this article is to summarize the data regarding pharmacodynamics, pharmacokinetics, possible drug interactions, adverse effects, dosing guidelines, equipotency with other opioid analgesics and clinical studies comparing efficacy, adverse reactions and safety of tramadol to other opioids in cancer pain treatment.
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Recent studies have suggested that melanocortins contribute to the generation and/or maintenance of pathological pain. Experimental evidence indicates a primary role for melanocortin 4 (MC4) receptors in pathological pain. In a previous study, we described the presence of MC4 receptor transcripts in the dorsal root ganglia (DRG). ⋯ Together, painful neuropathy resulted in the up-regulation of MC4 receptors in the spinal and peripheral nociceptive pathways. This up-regulation of MC4 receptors promotes the pronociceptive action of their endogenous ligands. Therefore, a block of the MC4 receptors results in the antagonism of neuropathic pain and such treatment could be beneficial therapeutically for individuals with chronic neuropathic pain.