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  • 1.
    Eriksson, Lars B
    et al.
    Department of Oral and Maxillofacial SurgeryCounty Hospital Falun, Sweden.
    Tegelberg, Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Safety of adjunct pre-emptive intravenous tramadol with midazolam sedation for third molar surgery2015In: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 19, no 4, p. 353-359Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of this study was to evaluate patient safety, in terms of adverse events, alterations in blood pressure or oxygen saturation (SpO2) in two routine sedation procedures, with and without intravenous analgesia.

    METHODS:

    Patients referred for surgical removal of mandibular third molars were treated in a randomized, controlled, single-blinded procedure. Eighty-seven men and women, aged 18 to 44 years, were allotted to either of two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S) or to a control group (C), given no sedation.

    RESULTS:

    Tramadol at 1 mg/kg body weight resulted in a higher frequency of oxygen desaturation (SpO2 < 90 %) than a placebo (p = 0.002) but had no effect on mean SpO2 at the end point or at the end of surgery. In both the test groups, there was a significant decrease in diastolic blood pressure (p < 0.001) from baseline to the end of surgery.

    CONCLUSION:

    The results confirm that pre-emptive intravenous tramadol, administered at 1 mg/kg body weight as an adjunct to midazolam sedation for third molar surgery, offers a safe method. But, it should be noted that our previous study shows that it is not a particularly effective analgesic. Further testing is therefore warranted, using other doses or other drugs, to find a better intravenous protocol for postoperative analgesia, with maximum effect and minimal risk, in outpatient oral and maxillofacial surgery procedures.

  • 2.
    Eriksson, Lars
    et al.
    Department of Oral and Maxillofacial SurgeryCounty Hospital, Falun, Sweden.
    Tegelberg, Åke
    Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery2013In: Oral and Maxillofacial Surgery, ISSN 1865-1550, E-ISSN 1865-1569, Vol. 17, no 3, p. 193-199Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics.

    MATERIAL AND METHODS:

    In a randomized, controlled, single-blinded procedure, 87 men and women aged 18-44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery.

    RESULTS:

    Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation.

    DISCUSSION AND CONCLUSION:

    The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.

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