Oral and Maxillofacial Surgery

, Volume 17, Issue 3, pp 193–199 | Cite as

Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery

  • Lars Eriksson
  • Åke Tegelberg
Original Article



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.


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.


Tramadol Postoperative analgesia Midazolam Third molar surgery Pain 



The authors thank Annelie Carlsson and Marie Svensson, research nurses, for their professional and invaluable role in the clinical accomplishment of the study; Håkan Flink, DDS, PhD, for meticulous monitoring of the study throughout the whole process; Jan Ifver, for his professional help with statistics; Pontus Carlsson, for his work with computer data input of all the patients and clinical numbers; and Harald Broberg, head of Department of Oral and Maxillofacial Surgery, Falu Lasarett, for his research friendly leadership. The study has received financial support from the research fund of Dental Board of the county of Dalarna, Sweden.

Conflict of interest

The authors declare that they have no financial or conflict of interest or have any association with the medical or pharmaceutical industry regarding the subject of this article.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryCounty HospitalFalunSweden
  2. 2.Department of Stomatognathic Physiology, Faculty of OdontologyMalmö UniversityMalmöSweden

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