Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery

Silvasti, M.; Tarkkila, P.; Tuominen, M.; Svartling, N.; Rosenberg, P. H.

doi:10.1097/00003643-199912000-00004

Cited by 48 publications

(20 citation statements)

References 13 publications

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“…O xycodone is a semi synthetic opioid with effects in both acute and chronic pain conditions 1–3 . Oxycodone is generally considered to be a μ‐opioid agonist 4,5 with a lower affinity for the receptor than morphine 6 .…”

mentioning

confidence: 99%

Impact of the CYP2D6 genotype on post‐operative intravenous oxycodone analgesia

Zwisler

Enggaard

Mikkelsen

et al. 2010

Acta Anaesthesiol Scand

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confidence: 99%

Impact of the CYP2D6 genotype on post‐operative intravenous oxycodone analgesia

Zwisler

Enggaard

Mikkelsen

et al. 2010

Acta Anaesthesiol Scand

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“…Oxycodone is a semisynthetic opioid with analgesic effect in many both acute and chronic pain conditions [1–3]. Its exact mechanism of action and opioid receptor interactions are not completely understood [4,5].…”

mentioning

confidence: 99%

The Hypoalgesic Effect of Oxycodone in Human Experimental Pain Models in Relation to the CYP2D6 Oxidation Polymorphism

Zwisler

Enggaard

Noehr-Jensen

et al. 2009

Basic Clin Pharma Tox

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Oxycodone is O-demethylated by CYP2D6 to oxymorphone which is a potent μ -receptor agonist. The CYP2D6 oxidation polymorphism divides the Caucasian population in two phenotypes: Approximately 8% with no enzyme activity, poor metabolizers (PM) and the remainder with preserved CYP2D6 activity, extensive metabolizers (EM). The objective of the study was to determine if the analgesic effect of oxycodone in human experimental pain depends on its metabolism to oxymorphone. The analgesic effect of oxycodone was evaluated in a randomized, placebo-controlled, double-blinded, crossover experiment including 33 (16 EM and 17 PM) healthy volunteers. Pain tests were performed before and 1, 2, 3 and 4 hr after medication and included pain detection and tolerance thresholds to single electrical sural nerve stimulation, pain summation threshold to repetitive electrical sural nerve stimulation and the cold pressor test with rating of discomfort and pain-time area under curve (AUC 0-2 min. ). For single sural nerve stimulation, there was a less pronounced increase in thresholds on oxycodone in pain detection (9% vs. 20%, P = 0.02, a difference of 11%, CI: 2%-20%) and pain tolerance thresholds (15% vs. 26%, P = 0.037, a difference of 10%, CI: 1%-20%) for PM compared with EM. In the cold pressor test, there was less reduction in pain AUC on oxycodone for PM compared with EM (14% vs. 26%, P = 0.012, a difference of 12%, CI: 3%-22%). The plasma oxymorphone/oxycodone ratio was significantly lower in PM compared with EM (P < 0.001). Oxycodone analgesia seems to depend both on oxycodone itself and its metabolite oxymorphone.Oxycodone is a semisynthetic opioid with analgesic effect in many both acute and chronic pain conditions [1][2][3]. Its exact mechanism of action and opioid receptor interactions are not completely understood [4,5]. The binding affinity of oxycodone to μ -opioid receptors is lower than that of morphine [6] but in vivo studies have found a higher efficacy of oxycodone compared with morphine [7]. This discrepancy suggests that the metabolites might play a role in the analgesic effect of oxycodone or that the analgesic effect is mediated via other opioid receptors.Oxycodone is metabolized in the liver by O-and Ndemethylation, 6-ketoreduction and conjugation with glucuronic acid [8]. Oxidation by N-demethylation via CYP3A4 is quantitatively the most important metabolizing route, but the metabolite noroxycodone produced only weak antinociceptive effect even at high doses, and therefore probably is of no clinical relevance for the analgesic effect of oxycodone [4,9]. The metabolite oxymorphone is formed by O-demethylation via CYP2D6 in the liver and accounts for approximately 11% of the oxycodone metabolized [10]. The μ -opioid receptor affinity of oxymorphone is 10 times higher than that of oxycodone [7], but following oxycodone administration, the concentration of oxymorphone in human plasma and urine is reported to be very low [11].Noroxymorphone, the metabolite of both noroxycodone and oxymorphone, is describe...

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“…No respiratory depression occurred in any of the patients during the study. Otherwise, nausea and vomiting are the most common adverse effects of tramadol [22,23,27,36,46]. Nausea was slightly more common in the tramadol alone and the combined groups and vomiting was seen only in 1 patient in the tramadol group in our study.…”

Section: Discussionmentioning

confidence: 49%

“…The safety of tramadol as an opioid analgesic without respiratory side effects at intravenous and epidural analgesic doses was proved in previous studies [22,23,27,28,35,45]. No respiratory depression occurred in any of the patients during the study.…”

Section: Discussionmentioning

confidence: 60%

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Patient-Controlled Epidural Analgesia after Major Urologic Surgeries

et al. 2003

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The efficiency and safety of patient-controlled epidural analgesia by using tramadol alone and combined with bupivacaine were investigated for postoperative pain treatment after major urological surgeries. For PCEA: in group I (n = 17) a loading dose of 20 mg tramadol with a continuous infusion of 1 mg/ml tramadol at a rate of 8 ml/h was given. In group II (n = 17), patients received an initial loading dose of 20 ml bupivacaine 0.125% and a supplemental continuous infusion of 8 ml/h. In group III (n = 17), a loading dose of 20 mg tramadol with 20 ml bupivacaine 0.125% were given and a supplemental infusion of 1 mg/ml tramadol in 20 ml bupivacaine 0.125% combination was begun with a rate of 8 ml/h. A demand epidural bolus dose of 5 ml with a lockout time of 30 min was also used in all patients. VAS for pain intensity, vital signs, sedation scale and side effects was monitored at 0, 15, 30 min and 1, 2, 3, 4, 8, 12, and 24 h of the postoperative period. Statistical significance was determined using Kruskal-Wallis, Fisher’s exact, analysis of variance for repeated measurements and Tukey tests. The hemodynamic values and sedation scales were insignificantly different (p > 0.05). The adequate analgesia was provided in all patients. However VAS values were significantly lower in group III than in groups I and II at every measurement (p < 0.05). The incidence of side effects in all three groups was low (p > 0.05). In conclusion, we suggested that a combination of tramadol with bupivacaine can provide the most effective and safe postoperative analgesia with minimal risk for side effects.

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Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery

Cited by 48 publications

References 13 publications

Impact of the CYP2D6 genotype on post‐operative intravenous oxycodone analgesia

Impact of the CYP2D6 genotype on post‐operative intravenous oxycodone analgesia

The Hypoalgesic Effect of Oxycodone in Human Experimental Pain Models in Relation to the CYP2D6 Oxidation Polymorphism

Patient-Controlled Epidural Analgesia after Major Urologic Surgeries

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