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

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Abstract

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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References

  1. Liedholm R (2005) Mandibular third molar removal. Thesis. University of Malmö, Sweden

    Google Scholar 

  2. Seymore RA, Meechan JG, Blair GS (1985) An investigation into postoperative pain and third molar surgery under local analgesia. Br J Oral Maxillofac Surg 23:410–418

    Article  Google Scholar 

  3. Fischer SE, McEntegart DJ (1988) Factors affecting the onset and severity of pain following the surgical removal of unilateral impacted mandibular third molar teeth. Br Dent J 164:351–354

    Article  Google Scholar 

  4. Henning Abrahamsson K (2003) Dental fear and oral health behavior. Thesis. Göteborg University, Sweden

    Google Scholar 

  5. Thomson WM, Locker D, Poulton R (2000) Incidence of dental anxiety in young adults in relation to dental treatment experience. Comm Dent Oral Epidemiol 28:289–294

    Article  CAS  Google Scholar 

  6. Meechan JG, Seymour RA (1993) The use of third molar surgery in clinical pharmacology. Br J Oral Maxillofac Surg 31:360–365

    Article  PubMed  CAS  Google Scholar 

  7. Lundgren S (1985) Sedation regimen in outpatient oral surgery. Thesis. University of Umeå, Sweden

    Google Scholar 

  8. Rune J, Ström C (1996) Midazolam intravenous conscious sedation in oral surgery. Swed Dent J 20:29–33

    Google Scholar 

  9. Roelofse JA, Van der Bijl P (1994) Cardiac dysrhythmias associated with intravenous lorazepam, diazepam and midazolam during oral surgery. J Oral Maxillofac Surg 52:247–250

    Article  PubMed  CAS  Google Scholar 

  10. Dionne RA, Yagiela JA, More PA, Gonty A, Zuniga J, Beirne R (2001) Comparing efficacy and safety of four intravenous sedation regimens in dental outpatient. JADA 132:740–750

    PubMed  CAS  Google Scholar 

  11. Zacharias M, MacD Hunter K, Parkinson R (1996) Respiratory effects of intravenous midazolam. N Z Dent J 92:76–79

    PubMed  CAS  Google Scholar 

  12. Hardeman JH, Sabol SR, Goldwasser MS (1990) Incidence of hypoxemia in the postanesthetic recovery room in patients having undergone intravenous sedation for outpatient oral surgery. J Oral Maxillofac Surg 48:942–944

    Article  PubMed  CAS  Google Scholar 

  13. Pozos AJ, Martinez R, Aguirre P (2007) Tramadol administered in combination of routes for reducing pain after removal of an impacted mandibular third molar. J Oral Maxillofac Surg 65:1633–1639

    Article  PubMed  Google Scholar 

  14. Kanto D, Salo M, Happonen RP, Vahlberg T, Kanto J (2005) Tramadol premedication in operative extraction of the mandibular third molar: a placebo-controlled crossover study. Acta Odontol Scand 63:43–49

    PubMed  CAS  Google Scholar 

  15. Ong KS, Lirk P, Tan J, Sow B (2005) The analgesic efficacy of intravenous versus oral tramadol for preventing postoperative pain after third molar surgery. J Oral Maxillofac Surg 63:1162–1188

    Article  PubMed  Google Scholar 

  16. Richmond CE, Bromely LM, Woolf CJ (1993) Preoperative morphine pre-empts postoperative pain. Lancet 342:73–75

    Article  PubMed  CAS  Google Scholar 

  17. Kiss I, Killan M (1992) Does opiate premedication influence postoperative analgesia? A prospective study. Pain 48:157–158

    Article  PubMed  CAS  Google Scholar 

  18. Collins M, Young I, Sweeney P, Fenn GC, Stratford ME, Wilson A, Harris M (1997) The effect of Tramadol on dento-alveolar surgical pain. Br J Oral Maxillofac Surg 35:54–58

    Article  PubMed  CAS  Google Scholar 

  19. Coulthard P, Snowdon AT, Rood JP (1996) The efficacy and safety of postoperative pain management with Tramadol for day case surgery. Ambulatory Surg 4:25–29

    Article  Google Scholar 

  20. Mattia C, Coluzzi F, Sarzi Puttini P, Viganó R (2008) Paracetamol/tramadol association: the easy solution for mild-moderate pain. Minerva Med 99:369–390

    PubMed  CAS  Google Scholar 

  21. Duthie DJ (1998) Remifentanil and tramadol. Br J Anaesth 81:51

    Article  PubMed  CAS  Google Scholar 

  22. ASA classification system (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  23. Owens WD, Felts JA, Spitzagel EL (1978) ASA physical status classification. Anesthesiology 49:239–243

    Article  PubMed  CAS  Google Scholar 

  24. Chernik DA, Gillings D, Laine H, Hendler J, Silver JM, Davidson AB, Schwam EM, Siegel JL (1990) Validity and reliability of the observer's assessment of alertness/sedation scale: study with intravenous sedation. J Clin Pharmacol 4:244–251

    Google Scholar 

  25. Liu J, Singh H, White P (1996) Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. Anaesthesiology 84:64–69

    Article  CAS  Google Scholar 

  26. Malviya T, Voepel-L AR, Tait AR, Merkel S, Tremper K, Naughton N (2002) Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan sedation scale (UMSS). Br J Anaesth 88:241–245

    Article  PubMed  CAS  Google Scholar 

  27. Todd KH, Funk KG, Funk JP, Bonacci R (1996) Clinical significance of reported changes in pain severity. Ann Emerg Med 4:485–489

    Article  Google Scholar 

  28. Todd KH, Funk JP (1996) The minimum clinically important difference in physician-assigned visual analog pain score. Acad Emerg Med 3:142–146

    Article  PubMed  CAS  Google Scholar 

  29. Moore A, Collins S, Carroll D, McQuay H, Edwards J (2004) Single-dose paracetamol (acetaminophen), with and without codeine, for postoperative pain. The Cochrane database of systematic reviews 1

  30. Rudin A, Eriksson L, Liedholm R, List T, Werner MU (2010) Prediction of postoperative pain after third molar surgery. J Orofac Pain 24:189–196

    PubMed  Google Scholar 

  31. Berggren U, Carlsson SG (1985) Usefulness of two psychometric scales in Swedish patients with severe dental fear. Comm Dent Oral Epidemiol 13:70–74

    Article  CAS  Google Scholar 

  32. Oosterink FMD, de Jongh A, Hoogestraten J (2009) Prevalence of dental fear and phobia relative to other fear and phobia subtypes. Eur J Oral Sci 117:135–143

    Article  PubMed  Google Scholar 

  33. Silvasti M, Tarkkila P, Tuominen M, Svartling N, Rosenberg PH (1999) Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. Eur J Anaesthesiol 16:834–839

    PubMed  CAS  Google Scholar 

  34. Shipton EA, Roelofse JA, Blignaut RJ (2003) An evaluation of analgesic efficacy and clinical acceptability of intravenous tramadol as an adjunct to propofol sedation for third molar surgery. Anesth Prog 50:121–128

    PubMed  CAS  Google Scholar 

  35. Gilliland HEM, Prasad BK, Mirakhur RK, Fee JPH (1996) An investigation of the potential morphine sparing effect of midazolam. Assoc Anaesth Great Brit Ireland 51:808–811

    CAS  Google Scholar 

  36. Clavier N, Lombard MC, Besson JM (1992) Bensodiazepines and pain: effects of midazolam on activities of nociceptive non-specific dorsal horn neurons in rat spinal cord. Pain 48:61–71

    Article  PubMed  CAS  Google Scholar 

  37. Ong CKS, Seymour RA, Tan JMH (2004) Sedation with midazolam leads to reduced pain after dental surgery. Anesth Analg 98:1289–1293

    Article  PubMed  CAS  Google Scholar 

  38. Coulthard P, Rood JP (1992) An investigation of effect of midazolam on pain experience. Br J Oral Maxillofac Surg 30:248–251

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

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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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, County Hospital, Falu Lasarett, Falun, 791 82, Sweden

    Lars Eriksson

  2. Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Malmö, 205 06, Sweden

    Åke Tegelberg

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  1. Lars Eriksson
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  2. Åke Tegelberg
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Correspondence to Lars Eriksson.

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Eriksson, L., Tegelberg, Å. Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery. Oral Maxillofac Surg 17, 193–199 (2013). https://doi.org/10.1007/s10006-012-0359-0

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  • DOI: https://doi.org/10.1007/s10006-012-0359-0

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