Aten Primaria. 1999 Nov 30;24(9):537-9.
[How we use opioid drugs on patients with neoplasms]

[Article in Spanish]

Rispau Falgas A, Soler Vila M, Garcia Bayo I, Valles Plasencia A, Saladich Puig R, Martinez Alemany V.

ABS Gava II, Barcelona.

OBJECTIVE: To find the pattern of use of opiate drugs for treating pain in terminal cancer patients. DESIGN: Retrospective descriptive study. SETTING: Gava 2 Health Centre, located in Barcelona's industrial belt. MATERIAL AND METHOD: Systematic review of the clinical records for the deaths recorded between May 1993 and March 1998. The following variables were recorded: age, sex, cause and place of death, professional attending patient during terminal phase, use of opiates (type, how they were taken, dosage and length of treatment) and prescribing doctor. RESULTS: Of the 429 deaths reviewed, 100 (23%) were caused by neoplasm (68% males), with an average age of 69 +/- 3 years. More than half the patients (55%) died at home. In the terminal phase they were mainly attended (69%) by their Primary Care team. 52% of the patients were given opiates, with morphine being the most common (71.1%), followed by codeine (40.3%) and tramadol (17.3%). The general practitioner was the prescribing agent in 69.2% of the cases. 76% of the patients who took codeine did so at infra-therapeutic doses (< 120 mg per day). Similarly, insufficient doses of morphine (< 60 mg per day) were given to half the patients who received it. 21.62% only took it during a period of 5 days or less before death. CONCLUSIONS: Primary care teams are taking on steadily greater protagonism in caring for terminal cancer patients. Although a large number of these patients are treated with opiates, these are given at often insufficient doses and for too short time periods.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10687223&dopt=Abstract tramadol Ultram

imiucca.csi.unimi.it

Tramadol is a centrally acting analgesic drug with a dual mechanism of action: binding to mu-opioid receptors and potentiation of the monoaminergic systems. In this study, we evaluated the effects of the acute and chronic administration of tramadol on nociceptive thresholds (by the hot-plate test) and on immune responses (by measuring Concanavalin A-induced splenocyte proliferation, IL-2 production and natural killer activity) in the mouse. After acute subcutaneous administration, tramadol induced antinociception starting from a dose of 20 mg/kg, whereas it significantly enhanced natural killer activity and IL-2 production at doses as low as 1 mg/kg and splenocyte proliferation starting from a dose of 10 mg/kg. After the chronic administration, the antinociceptive effect of the drug was still present, whereas the immune modifications disappeared. Thus, the pharmacological profile of tramadol is totally different from that of other drugs which bind mu-opioid receptors. Our results suggest that tramadol could be a good choice for the treatment of pain in patients where immunosuppression may be particularly contraindicated.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9313273&dopt=Abstract tramadol Ultram




J Indian Med Assoc. 1997 Apr;95(4):105-6.
Role of epidural tramadol hydrochloride on postoperative pain relief in caesarean section delivery.

Pan AK, Mukherjee P, Rudra A.

NRS Medical College and Hospital, Calcutta.

Two groups comprising 25 patients in each went for caesarean section delivery under epidural anaesthesia. Group I patients received 50 mg (1 ml) of tramadol hydrochloride with 14 ml of 2% lignocaine with adrenaline (1:200,000) and group II cases received 15 ml of 2% lignocaine with adrenaline (1:200,000). Both the groups of patients were comparable in age and body weight. In both the groups, there were good operative conditions, insignificant changes in pulse and blood pressure. The neonatal status was also similar in both the groups. The patients belonging to group I showed longer duration (15.39 +/- 0.45 hours) of analgesia in comparison to group II patients (2.46 +/- 0.54 hours).

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9357271&dopt=Abstract tramadol Ultram




Med Clin (Barc). 1997 Sep 13;109(8):281-3.
[Changes in the pattern of opioid analgesic consumption in Spain]

[Article in Spanish]

Carvajal A, Garcia del Pozo J, Martin Arias LH, Martin de Diego I, Rueda AM, Caro-Paton T, Alvarez Requejo A.

Centro Regional de Farmacovigilancia, Universidad de Valladolid.

BACKGROUND: Data from different sources have proved an infrautilization of opioid analgesics in Spain. A descriptive study has been conducted in order to know the utilization of these drugs and changes in the pattern of use in the last few years. MATERIAL AND METHOD: To know the consume of narcotic analgesic drugs, N02A group of the Anatomic Therapeutic Classification, a search was developed in the ECOM database from the Spanish Ministry of Health. This database contains information of drug preparations prescribed throughout the National Health Care System. RESULTS: The consumption of opioid analgesics in Spain has been multiplied by 5.2 during this period. It has increased from 94.7 defined daily dose per 1,000,000 inhabitants in 1985 to 489.4 in 1994. The most consumed drug in 1994 was dihydrocodeine, followed by tramadol. The number of defined daily dose per inhabitant and day of parenteral administration have decreased during the last years. CONCLUSIONS: Availability of new analgesic opioid drugs with better pharmacokinetic profiles has contributed to an increase of their consume in Spain.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9379748&dopt=Abstract tramadol Ultram




Rev Esp Anestesiol Reanim. 1997 Oct;44(8):330-2.
[Tramadol in elastomeric continuous perfusion for analgesia after gynecologic surgery]

[Article in Spanish]

Izquierdo-Mediavilla A, Garcia-Escobar M, Gonzalez-Machado JL.

Servicio de Anestesia-Reanimacion y Unidad del Dolor, Hospital Clinico Universitario San Juan de Alicante.

Quality of analgesia provided by continuous infusion of tramadol through an elastomeric infuser (Baxter PC1071) was studied in a group of 40 women undergoing laparotomy to treat non tumoral disease. After a loading dose of 100 mg of tramadol in the recovery room, the elastomeric infuser was connected, loaded with 300 mg of tramadol in 48 ml of saline. The patient was then transferred to the ward. Analgesic quality was assessed on a visual analog scale (VAS) of 1 to 10 and on a semantic scale. Side effects, the need for supplemental analgesia and the opinion of the nurse were all recorded. The highest VAS score in the 24 h period was 2.69. Pain was described as slight by 52.5% of the women, moderate by 12.5% and absent by 35%. The main side effects were nausea and vomiting (12.5%). Three patients needed supplementary analgesia. The technique was described by 85% of the nurses as good (62.5%) or very good (22.5%). Elastomeric infusers are an effective way to deliver analgesics, and tramadol proved to be a valid analgesic for continuous infusion.

Tramadol reference source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9424689&dopt=Abstract tramadol Ultram