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The dose response curve for tramadol hydrochloride in man
s268 Opiate Analgesia - Clinical THE DDSE RESPONSE CURVE FOR TRAMADOL HYDROCHLORIDE IN MAN. Keith Budd, Pain Relief Service, The Royal Infirmary, Bradford West Yorkshire, U.K.
BD9 6RJ,
ACC Hall A AIM OF INVESTIGATION: The study was to determine the log dose/response curve for tramadol hvdrochloride in man and the side effect profile. METHOD: 25 adult patients (16 male, 9 female) were studied’ in the immediate postapse period following surgery on limbs, estimated to produce appproximately equivalent pain. Following premeditation with an oral benzodiazepine, general anaesthesia was maintained with oxygen, nitrous oxide and a volatile agent. After the completion of surgery, following full wakening, a measure of each patients pain was made using a visual analogue scale (VAS) A second measure was made five minutes later and if the VAS score was greater than 50% tramadol hydrochloride was given towards the pain end or the patient requested analgesia, intravenously in 25 mgm aliquots every three minutes until the pain was completely obtunded and the limb could be moved without causing the patient to complain of pain. VAS scores were measured immediately before each aliquot of drug was given and five minutes after the last. respiratory rate and side effects were also recorded at each Pulse, blood pressure, stage. RESULTS: The results were plotted as a log dose/ response(VAS) in a standard manner toxe a conglomerate curve. The sigmoid curve produced showed a median effective dose (ED501 of 76.5 mgs and a maximal effective dose of 110 mgs. changes were seen in the physiological parameters measured and the only No significant side effect seen was nausea in five patients (4 male, 1 female) CONCLUSIONS: The results show a close correlation between the dose response curves drawn for each patient. The efficacy and side effect profile indicate that tramadol hydrochloride has marked potential in the middle range of analgesics.
TRAMADOLHYDROCHLORIDE:ABSENCE OF RESPIRATORYDEPRESSIONCOMPARED TO MORPHINE IN POST-OPERATiVEPAiN REUEF M. Voeta*. R.J. Haumes*, A. Verkaaik*, W. Erdmann, dept. of Aneatheeia,ErasmusUnlveraity,3OW DR Rotterdam,The Netherlands.
m
508 Thurs ACC
Slide 3:15 Hall
A
u: Previous experience in our unit has confirmed that morphine, though being for many years the standard potent reference armigeak, can produce a potentially dangerous degree of respiratory depre&m. Recent information has suggeeted that the opiokl agonist tramadoi produces anaige& wfthout ciln&dly eign&aht respiratorydepreeaion. Therefore, we compared the relattve potencies of morphine and tmmadoi in pain relief foiiowlnggynecologlcdoperations,andtheir infiuenceon arteriaioxygensaturation. DESIGN: Patients were randomized douMe-Mind into stratified moderate or severe pain groups and received either 50 mg tramadd or 5 mg morphine intravenouslyas required up to three times over the first hour. Pain relief was aaaeeaed over the succeedingsix hours; oxygen saturationwas continuoueiymeaeumd by P&e Oximetry over ‘two hours foliowing each study injection. Hypoxemia requiring intewentiw was deftned ae 86% aatufatkn~ equivaienttoanartedafoxygenMsbnof5OmmHg. m: Both tramadd and morphine produced acceptabfe pain reiief, morphine proving more effkadous in the severe pain group. in lB% of moqAne patlents, but none of the tramadd patfents, the oxygen eaturaflon fell to below 86%; in 43% of the former, the drop occurred after only 5 mg of morphine. intmy, in two cases interventionwas requiredouteidethe ueuaiclinicalobgenrationperkxi - evenafter 1 hour40 minutes. m: Published data supports a 1O:l mg-ratio efficacy claim for tramadd to morphine. Our study genera@ umflmxd this, aithough the difference observed in the severe pain group could have reeuited from the low init& loadingdose of tramadd. However, in demoMmti ng the absence of dinkxliy relevant respiratorydepression with tramadd, we undedined one of the potentfai dangers of morphine use, and woukl therefore suggest first-iine uae of tramadd in this indicationand resortto morphineonly if absoiuteiynecessary.
I
BD9 6RJ,
ACC Hall A AIM OF INVESTIGATION: The study was to determine the log dose/response curve for tramadol hvdrochloride in man and the side effect profile. METHOD: 25 adult patients (16 male, 9 female) were studied’ in the immediate postapse period following surgery on limbs, estimated to produce appproximately equivalent pain. Following premeditation with an oral benzodiazepine, general anaesthesia was maintained with oxygen, nitrous oxide and a volatile agent. After the completion of surgery, following full wakening, a measure of each patients pain was made using a visual analogue scale (VAS) A second measure was made five minutes later and if the VAS score was greater than 50% tramadol hydrochloride was given towards the pain end or the patient requested analgesia, intravenously in 25 mgm aliquots every three minutes until the pain was completely obtunded and the limb could be moved without causing the patient to complain of pain. VAS scores were measured immediately before each aliquot of drug was given and five minutes after the last. respiratory rate and side effects were also recorded at each Pulse, blood pressure, stage. RESULTS: The results were plotted as a log dose/ response(VAS) in a standard manner toxe a conglomerate curve. The sigmoid curve produced showed a median effective dose (ED501 of 76.5 mgs and a maximal effective dose of 110 mgs. changes were seen in the physiological parameters measured and the only No significant side effect seen was nausea in five patients (4 male, 1 female) CONCLUSIONS: The results show a close correlation between the dose response curves drawn for each patient. The efficacy and side effect profile indicate that tramadol hydrochloride has marked potential in the middle range of analgesics.
TRAMADOLHYDROCHLORIDE:ABSENCE OF RESPIRATORYDEPRESSIONCOMPARED TO MORPHINE IN POST-OPERATiVEPAiN REUEF M. Voeta*. R.J. Haumes*, A. Verkaaik*, W. Erdmann, dept. of Aneatheeia,ErasmusUnlveraity,3OW DR Rotterdam,The Netherlands.
m
508 Thurs ACC
Slide 3:15 Hall
A
u: Previous experience in our unit has confirmed that morphine, though being for many years the standard potent reference armigeak, can produce a potentially dangerous degree of respiratory depre&m. Recent information has suggeeted that the opiokl agonist tramadoi produces anaige& wfthout ciln&dly eign&aht respiratorydepreeaion. Therefore, we compared the relattve potencies of morphine and tmmadoi in pain relief foiiowlnggynecologlcdoperations,andtheir infiuenceon arteriaioxygensaturation. DESIGN: Patients were randomized douMe-Mind into stratified moderate or severe pain groups and received either 50 mg tramadd or 5 mg morphine intravenouslyas required up to three times over the first hour. Pain relief was aaaeeaed over the succeedingsix hours; oxygen saturationwas continuoueiymeaeumd by P&e Oximetry over ‘two hours foliowing each study injection. Hypoxemia requiring intewentiw was deftned ae 86% aatufatkn~ equivaienttoanartedafoxygenMsbnof5OmmHg. m: Both tramadd and morphine produced acceptabfe pain reiief, morphine proving more effkadous in the severe pain group. in lB% of moqAne patlents, but none of the tramadd patfents, the oxygen eaturaflon fell to below 86%; in 43% of the former, the drop occurred after only 5 mg of morphine. intmy, in two cases interventionwas requiredouteidethe ueuaiclinicalobgenrationperkxi - evenafter 1 hour40 minutes. m: Published data supports a 1O:l mg-ratio efficacy claim for tramadd to morphine. Our study genera@ umflmxd this, aithough the difference observed in the severe pain group could have reeuited from the low init& loadingdose of tramadd. However, in demoMmti ng the absence of dinkxliy relevant respiratorydepression with tramadd, we undedined one of the potentfai dangers of morphine use, and woukl therefore suggest first-iine uae of tramadd in this indicationand resortto morphineonly if absoiuteiynecessary.
I