Pharmacokinetics of rectal tramadol in postoperative paediatric patients

Zwaveling, J.; Bubbers, Sally; Meurs, A.H.J. van; Schoemaker, Rik C.; Heel, Isabelle Ruijs-Dudok van; Vermeij, P.; Burggraaf, Jacobus

doi:10.1093/bja/aeh178

Cited by 36 publications

(23 citation statements)

References 16 publications

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“…Rectal administration of tramadol has never been tested in animals, whereas two studies have been conducted in paediatric (Zwaveling et al 2004) and adult (Lintz et al 1998) human patients. Those studies showed a higher bioavailability of tramadol Giorgi et al after rectal than oral administration, and it was suggested to be due to fi rst-pass metabolism, which was generally more pronounced with the oral formulations (Lintz et al 1998;Giorgi et al 2009b).…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of tramadol and its major metabolites following rectal and intravenous administration in dogs

Giorgi

Carlo

Saccomanni

et al. 2009

New Zealand Veterinary Journal

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of tramadol and its major metabolites following rectal and intravenous administration in dogs

Giorgi

Carlo

Saccomanni

et al. 2009

New Zealand Veterinary Journal

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“…A rectal dose of 1.5–2.0 mg/kg is therapeutic. [1] Therefore, a dose of 100 mg was used in our study for suppository. Tramadol is rapidly distributed after i.v.…”

Section: Discussionmentioning

confidence: 99%

“…Tramadol hydrochloride is a centrally acting opioid analgesic, which acts on mu opioid receptors, and is classified as a phase II analgesic according to the WHO pain score. [1] Tramadol is an analgesic with mixed opioid and nonopioid activities. [23] The nonopioid component is mediated through alfa-2 agonist and serotonergic activity, which it exerts by inhibiting the reuptake of norepinephrine and 5-hydroxytryptamine in the central nervous system and possibly by displacing the stored 5-HT from the nerve endings.…”

Section: Introductionmentioning

confidence: 99%

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Comparative study of the analgesic efficacy of rectal tramadol versus intravenous tramadol for adult tonsillectomy

Gadani

Chaudhary

2010

Anesth Essays Res

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Background:The optimal method for intra- and post-operative analgesia for adult tonsillectomy is uncertain. Tramadol hydrochloride is an analgesic with mixed mu and nonopioid activities, having less/no respiratory depression.Aim:The aim of our study was to compare the analgesic efficacy and nausea/vomiting produced by tramadol via intravenous and rectal administration during the first 24 h after anesthesia for adult tonsillectomy.Materials and Methods:The study design was prospective, randomized, single blind and hospital based. Forty adult patients of ASA grade 1 and 2 posted for tonsillectomy were randomized to receive either intravenous tramadol (1 mg/kg) (n=20) Group A or rectal tramadol (1.5–2 mg/kg), maximum 100 mg (n=20), Group B immediately after the induction of anesthesia. Pain measurement was performed using visual analogue scale. Rescue analgesia was given when the VAS was ≥3 in the postoperative period up to 24 h. Complaint of nausea/vomiting was recorded during the same period.Results:Duration of analgesia was prolonged and requirement of rescue analgesics was less with the suppository group. Nausea and vomiting were lower with the suppository group.Conclusion:The rectal route of tramadol is a better alternative to the intravenous route in comparison with the duration of analgesia and nausea/vomiting for adult tonsillectomy.

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“…Rectal bioavailability is good with low interindividual variability (Zwaveling et al, 2004). Maximum plasma concentrations post IV, oral and rectal dosing are achieved between 0.3 and 2.4 hours postadministration (Bozkurt, 2005).…”

Section: Pharmacokineticsmentioning

confidence: 97%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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Pharmacokinetics of rectal tramadol in postoperative paediatric patients

Abstract: The study showed that after rectal administration, tramadol is absorbed at a reasonable rate and with a low inter-individual variability in small children. The data also suggested that a rectal dose of tramadol 1.5-2.0 mg kg(-1) is therapeutic.

Cited by 36 publications

References 16 publications

Pharmacokinetics of tramadol and its major metabolites following rectal and intravenous administration in dogs

Pharmacokinetics of tramadol and its major metabolites following rectal and intravenous administration in dogs

Comparative study of the analgesic efficacy of rectal tramadol versus intravenous tramadol for adult tonsillectomy

Safety of opioid patch initiation in Australian residential aged care

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