European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Jan 2003
Randomized Controlled Trial Meta Analysis Clinical TrialMeta-analysis of single dose oral tramadol plus acetaminophen in acute postoperative pain.
Trials in acute postoperative pain are usually small. Pooling homogenous data from a number of trials in a meta-analysis enables a truer estimate of efficacy. The aims of the present meta-analysis were to assess the analgesic efficacy and adverse effects of single-dose oral tramadol plus acetaminophen (paracetamol) in acute postoperative pain, and to demonstrate the efficacy of the combination formulation compared with its components. ⋯ Meta-analysis confirmed the analgesic superiority of the combination treatment over its components, without additional toxicity. Combination analgesic formulations are an important and effective means of pain relief, and should prove useful in treating elderly and other groups of patients who often cannot tolerate non-steroidal anti-inflammatory drugs, including the newer COX-2 inhibitors.
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Eur J Anaesthesiol Suppl · Jan 2003
ReviewState of the art of pain treatment following ambulatory surgery.
The growth of ambulatory surgical procedures is limited by severe postoperative pain. After particularly painful operative procedures, moderate-to-severe pain is estimated to occur in approximately 30% of patients. Inadequate analgesia may delay or prevent discharge, or result in readmission. Severe postoperative pain also causes extreme discomfort and can prevent sleep, thus contributing to postoperative fatigue. Moreover, postoperative pain limits mobility at home and delays the return to normal activities. The development of effective analgesia for postoperative pain is therefore a priority of modern medicine. ⋯ Postoperative pain is the most commonly reported complication of ambulatory surgery. Although the number of analgesic techniques seems more limited in outpatient than in inpatient surgery, the combination of analgesic regimens in a multimodal approach may improve postoperative analgesia and functional outcome after ambulatory surgery. The combination of acetaminophen plus tramadol is a useful formulation to prescribe if acetaminophen or NSAIDs alone are ineffective.
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Eur J Anaesthesiol Suppl · Jan 2003
ReviewClinical pharmacology and rationale of analgesic combinations.
Oral fixed drug combination analgesics have potential advantages over monotherapy, but these can only be attained through careful design. ⋯ In summary, combination analgesics can play a valuable role in pain management. However, dubious combinations (directed against the same targets or with unwanted interactions) and 'old fashioned' fixed-dose multiple analgesic agent combinations should be avoided. Fixed-dose combination analgesics are of value only when they have been developed according to rational pharmacokinetic and pharmacodynamic criteria, and when claims for their benefits have been supported by evidence-based data and well-designed clinical studies.
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Combinations of analgesic drugs provide the opportunity for better efficacy with less overall morbidity than provided by single analgesic agents. This article discusses the rationale, efficacy and safety for a novel analgesic combination: tramadol and acetaminophen (paracetamol). ⋯ Tramadol/acetaminophen combination is a new preparation that is effective in acute or chronic moderate-to-moderately severe pain. It benefits from the complementary actions of the constituent analgesics, having the rapid onset of acetaminophen and the sustained effect of tramadol. The analgesic efficacy of this combination is comparable to that of positive controls, and its adverse event profile is in line with that of its single components.