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Compared with nonsteroidal anti-inflammatory drugs (NSAIDs), Tramadol does not aggravate hypertension or congestive heart failure, nor does it have the potential to cause peptic ulcer disease.

Compared with narcotics (opioid analgesics), Tramadol does not induce significant respiratory depression, constipation, or have significant abuse potential.

• Efficacy:
• Postoperative analgesia after tonsillectomy: Both analgesics are effective for postoperative pain relief in children after tonsillectomy. However, morphine may give better postoperative pain relief 1. Tramadol is better tolerated.
• Postoperative analgesia after urological surgery: In the postoperative period, pain scores and the average time for analgesic requirement are similar for both drugs. However, the incidences of allergic rash, itching, respiratory depression and sedation score are greater with the morphine 19.
• Posttraumatic pain: Analgesia is similar with both tramadol and morphine for the management of pain in trauma 2.
• Pain after abdominal surgery: Tramadol given by intramuscular injection has postoperative analgesic activity similar to morphine. In multicenter trial comparing tramadol and morphine for pain after abdominal surgery after the first dose, pain intensity was reduced 36.2% with tramadol, and 51% with morphine 3.
• Postoperative pain: Tramadol shows pain relief similar to morphine 4.
• Severe pain: For patients with severe pain, the efficacy of morphine is superior.
• Chronic pancreatitis: Tramadol and morphine are potent analgesics in severe chronic pancreatitis pain when individually titrated. However, in clinical study tramadol interfered significantly less with gastrointestinal function and was more often rated as an excellent analgesic than morphine 17.
• Intraoperative analgesia: In clinical study there was no difference between the use of tramadol and morphine to treat pain after laparoscopic cholecystectomy from 90 min after the end of surgery. Morphine was more effective than tramadol as an intraoperative analgesic 26.
  
• Side effects and tolerability:
  Tramadol appeared to cause more nausea and vomiting than morphine. Morphine produces more sleepiness 18.
  Tramadol has smaller inhibitory effect on gastric emptying compared with morphine 14.

The analgesic efficacy of 50 and 100 mg tramadol and 500 and 1,000 mg metamizole was compared using a randomized double-blind design on 10 volunteers; drugs were given orally as solutions. Constant painful stimuli were applied by controlled electrical stimulation of tooth pulp. Analgesia was monitored by verbal pain rating, by measurement of the current necessary to evoke sensation in a tooth and with the aid of the amplitude of somatosensory evoked potential. All 3 algesimetric methods showed in complete agreement higher analgesia by the 100-mg dose of tramadol compared to all other medications. The mean relative potencies of metamizole and tramadol were found to be 1:23 in agreement with clinical studies 5.

• Postoperative pain: Buprenorphine appears to produce more potent and longer acting analgesic effect compared to tramadol, although slightly delayed 27.

• Postoperative pain: In clinical trial the first dose of tramadol was significantly more effective than pentazocine after the 1st h and throughout the subsequent 5 h. Final judgments on efficacy and acceptability were in favor of tramadol 28.
• Postoperative pain following prolapsed intervertebral disc repair: Results of the comparative study showed both treatments provide equivalent effective analgesia for the six hours observation period. The global assessment of analgesia by patient and observer was not significantly different for both treatments, although less additional medication was required in the pentazocine group. Side effects were quite common in both groups, and occurred more frequently in the pentazocine group 29.
• Acute pain: Tramadol (50 mg) has shown to have an analgesic effect about equal to that of the pentazocine (50 mg). Both analgesics are superior in effect to the placebo. The incidence of side effects from tramadol appears to be less than that with the pentazocine 29.

• Efficacy:
• Labour pain: Tramadol 100 mg is as effective as pethidine 75 mg 6.
• Analgesia for adenotonsillectomy: The results of comparative study suggest that pethidine given with induction of anaesthesia provides better analgesia during and after tonsillo-adenoidectomy than does tramadol. The delay to recovery of spontaneous respiration with pethidine suggests a greater safety profile of tramadol 20.
• Side effects and tolerability:
  Tramadol has superior safety profile. Pethidine is associated with a significantly higher frequency of adverse events and a significantly lower respiratory rate in the neonates 6.
  In comparative study tramadol was shown not to be associated with respiratory depression, unlike equipotent dose of pethidine 9.

• Efficacy:
• Postoperative pain: The 75 mg dose of tramadol is generally more effective than the acetaminophen-propoxyphene combination (650/100 mg). The 150 mg dose of tramadol is significantly superior to the acetaminophen-propoxyphene 7.
• Side effects and tolerability: Tramadol 150 mg is associated with higher frequency of dizziness 7.

• Efficacy:
• Postoperative pain: Meperidine and tramadol produce comparable analgesia, with a different time course profile 11.
• Postoperative pain relief after tonsillectomy: Meperidine appears to be more effective for pain relief and provides better emergence characteristics than tramadol after tonsillectomy in children 21.
  
• Side effects and tolerability:
  Meperidine induces sedation and respiratory depression while tramadol does not. Incidence of nausea and vomiting is higher with tramadol 11.

• Efficacy:
• Postoperative pain after maxillofacial surgery: In comparative study the potency ratio of tramadol to oxycodone was found to be approximately 8:1. There was no significant difference between the medications in the VAS scores for pain. Tramadol was found to provide adequate analgesia after maxillofacial surgery without risk of respiratory depression 24.
• Side effects and tolerability:
  Incidence of nausea is slightly greater with tramadol than with oxycodone 24.
  Oxycodone causes significant respiratory depression. On the contrary, Tramadol is not associated with respiratory depression 10.

Heroin withdrawal management: Comparative study indicates that tramadol is more effective in managing withdrawal than clonidine, and may be especially useful in outpatient detoxification 12.

• Efficacy:
• Acute musculoskeletal pain: Tramadol provides inferior analgesia to hydrocodone-acetaminophen in patients with acute musculoskeletal pain 25.
• Side effects and tolerability:
• Abuse/dependence potencial: Tramadol abuse/dependence potencial is significantly less than for hydrocodone 13.

• Efficacy:
• Renal colic: Both ketorolac (30 mg intramuscular) and tramadol (1 mg/kg subcutaneous) are effective in the initial treatment of renal colic. Both drugs have an efficacy greater than 80% when used separately and almost 100% when used in combination. The analgesic effect of ketorolac is observed earlier than that of tramadol 8.
• Postoperative pain during maxillofacial surgery: Ketorolac and Tramadol produce comparable, effective and low cost postoperative analgesia during maxillofacial surgery 22.
• Laparoscopic procedure: Tramadol is a better analgesic compared to ketorolac for patients undergoing day care gynaecological laparoscopic procedure 23.
• Side effects and tolerability: Tramadol is associated with higher incidence of vomiting 22.

• Efficacy:
• Acute migraine attacks: The comparative study evaluated the efficacy of intramuscular tramadol 100 mg in the treatment of acute migraine attack and compared it with that of IM diclofenac sodium 75 mg.
  Two-hour pain response rate was 80% for both tramadol and diclofenac groups. There were no statistically significant differences among groups in terms of 48-h pain response, rescue treatment, associated symptoms' response, headache recurrence and adverse event rates. Fifteen (75%) patients in the tramadol group and 16 (80%) patients in the diclofenac group stated that they may prefer the same agent for future admissions 15.
• Posttonsillectomy analgesia: Oral tramadol can deliver the same analgesic efficacy as oral diclofenac for posttonsillectomy pain relief, which might be beneficial for avoiding the adverse effects of nonsteroidal anti-inflammatory drug therapy 30.
  
• Side effects and tolerability:

• Efficacy:
• Postoperative pain: The randomized double-blind study compared the analgesic efficacy and tolerability of intramuscular lornoxicam and tramadol in 76 patients with moderate to unbearable pain following arthroscopic reconstruction of the anterior cruciate ligament using the patella bone-tendon-bone technique. Patients receiving a single dose of lornoxicam 16 mg experienced significantly greater total pain relief than patients receiving tramadol 100 mg over the following 8 hours. Lornoxicam had greater analgesic efficacy than tramadol in patients with moderate baseline pain but was of equivalent efficacy in those with severe/unbearable baseline pain. Fewer patients in the lornoxicam group required rescue medication (58% vs. 77%, respectively). Patients' global impression of efficacy showed lornoxicam to be superior to tramadol with 82% and 49% of patients, respectively, rating treatment as good, very good, or excellent. Following multiple-dose administration of lornoxicam (8 mg tid) or tramadol (100 mg tid) for 3 days, efficacy profiles similar to those following a single dose were obtained. Thus, slightly fewer patients in the lornoxicam group required rescue medication, and patients' global impression of efficacy again favored lornoxicam 16.
• Side effects and tolerability: Significantly fewer patients reported one or more adverse events with lornoxicam than with tramadol (14 vs. 24, respectively) 16.

• Tramadol (Ultram) Medical Facts

• 1. Ozalevli M, Unlu"genc, H, Tuncer U, Gu"nes, Y, Ozcengiz D. Comparison of morphine and tramadol by patient-controlled analgesia for postoperative analgesia after tonsillectomy in children. Paediatr Anaesth. 2005 Nov;15(11):979-84. PubMed
• 2. Vergnion M, Degesves S, Garcet L, Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg. 2001 Jun;92(6):1543-6. PubMed
• 3. Gritti G, Verri M, Launo C, Palermo S, Novelli GP, Casali R, Paoletti F, Boanelli A, Tufano R, Leone D. Multicenter trial comparing tramadol and morphine for pain after abdominal surgery. Drugs Exp Clin Res. 1998;24(1):9-16. PubMed
• 4. Casali R, Lepri A, Cantini Q, Landi S, Novelli GP. Comparative study of the effects of morphine and tramadol in the treatment of postoperative pain. Minerva Anestesiol. 2000 Mar;66(3):147-52. PubMed
• 5. Rohdewald P, Granitzki HW, Neddermann E. Comparison of the analgesic efficacy of metamizole and tramadol in experimental pain. Pharmacology. 1988;37(4):209-17. PubMed
• 6. Viegas OA, Khaw B, Ratnam SS. Tramadol in labour pain in primiparous patients. A prospective comparative clinical trial. Eur J Obstet Gynecol Reprod Biol. 1993 May;49(3):131-5. PubMed
• 7. Sunshine A, Olson NZ, Zighelboim I, DeCastro A, Minn FL. Analgesic oral efficacy of tramadol hydrochloride in postoperative pain. Clin Pharmacol Ther. 1992 Jun;51(6):740-6. Related Articles, Links PubMed
• 8. Nicola's Torralba JA, Rigabert Montiel M, Ban~o'n Pe'rez V, Valdelvira Nadal P, Pe'rez Albacete M. Intramuscular ketorolac compared to subcutaneous tramadol in the initial emergency treatment of renal colic. Arch Esp Urol. 1999 Jun;52(5):435-7. PubMed
• 9. Tarkkila P, Tuominen M, Lindgren L. Comparison of respiratory effects of tramadol and pethidine. Eur J Anaesthesiol. 1998 Jan;15(1):64-8. PubMed
• 10. Tarkkila P, Tuominen M, Lindgren L. Comparison of respiratory effects of tramadol and oxycodone. J Clin Anesth. 1997 Nov;9(7):582-5. PubMed
• 11. Tarradell R, Pol O, Farre' M, Barrera E, Puig MM.Respiratory and analgesic effects of meperidine and tramadol in patients undergoing orthopedic surgery. Methods Find Exp Clin Pharmacol. 1996 Apr;18(3):211-8. PubMed
• 12. Sobey PW, Parran TV, Grey SF, Adelman CL, Yu J. The use of tramadol for acute heroin withdrawal: a comparison to clonidine. J Addict Dis. 2003;22(4):13-25. PubMed
• 13. Adams EH, Breiner S, Cicero TJ, Geller A, Inciardi JA, Schnoll SH, Senay EC, Woody GE. A comparison of the abuse liability of tramadol, NSAIDs, and hydrocodone in patients with chronic pain. J Pain Symptom Manage. 2006 May;31(5):465-76. PubMed
• 14. Crighton IM, Martin PH, Hobbs GJ, Cobby TF, Fletcher AJ, Stewart PD. A comparison of the effects of intravenous tramadol, codeine, and morphine on gastric emptying in human volunteers. Anesth Analg. 1998 Aug;87(2):445-9. PubMed
• 15. Engindeniz Z, Demircan C, Karli N, Armagan E, Bulut M, Aydin T, Zarifoglu M. Intramuscular tramadol vs. diclofenac sodium for the treatment of acute migraine attacks in emergency department: a prospective, randomised, double-blind study. J Headache Pain. 2005 Jun;6(3):143-8. Epub 2005 May 13. PubMed
• 16. Staunstrup H, Ovesen J, Larsen UT, Elbaek K, Larsen U, Kr?ner K. Efficacy and tolerability of lornoxicam versus tramadol in postoperative pain. J Clin Pharmacol. 1999 Aug;39(8):834-41. PubMed
• 17. Wilder-Smith CH, Hill L, Osler W, O'Keefe S. Effect of tramadol and morphine on pain and gastrointestinal motor function in patients with chronic pancreatitis. Dig Dis Sci. 1999;44:1107–1116. doi: 10.1023/A:1026607703352. PubMed
• 18. Pang WW, Mok MS, Lin CH, Yang TF, Huang MH. Comparison of patient-controlled analgesia (PCA) with tramadol or morphine. Can J Anaesth. 1999 Nov;46(11):1030-5. PubMed
• 19. Demiraran Y, Kocaman B, Akman RY. A comparison of the postoperative analgesic efficacy of single-dose epidural tramadol versus morphine in children. Br J Anaesth. 2005 Oct;95(4):510-3. Epub 2005 Aug 12. PubMed
• 20. van den Berg AA, Montoya-Pelaez LF, Halliday EM, Hassan I, Baloch MS. Analgesia for adenotonsillectomy in children and young adults: a comparison of tramadol, pethidine and nalbuphine. Eur J Anaesthesiol. 1999 Mar;16(3):186-94. PubMed
• 21. Ozer Z, Go"ru"r K, Altunkan AA, Bilgin E, Camdeviren H, Oral U. Efficacy of tramadol versus meperidine for pain relief and safe recovery after adenotonsillectomy. Eur J Anaesthesiol. 2003 Nov;20(11):920-4. PubMed
• 22. Zackova M, Taddei S, Calo` P, Bellocchio A, Zanello M. Ketorolac vs tramadol in the treatment of postoperative pain during maxillofacial surgery. Minerva Anestesiol. 2001 Sep;67(9):641-6. PubMed
• 23. Ali A, Chohan U, Atiq F. Intravenous tramadol vs ketorolac in laparoscopic dye test. J Coll Physicians Surg Pak. 2006 Jan;16(1):3-6. PubMed
• 24. Silvasti M, Tarkkila P, Tuominen M, Svartling N, Rosenberg PH. Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. Eur J Anaesthesiol. 1999 Dec;16(12):834-9. PubMed
• 25. Turturro MA, Paris PM, Larkin GL. Tramadol versus hydrocodone-acetaminophen in acute musculoskeletal pain: a randomized, double-blind clinical trial. Ann Emerg Med. 1998 Aug;32(2):139-43. PubMed
• 26. Naguib M, Seraj M, Attia M, Samarkandi AH, Seet M, Jaroudi R. Perioperative antinociceptive effects of tramadol. A prospective, randomized, double-blind comparison with morphine. Can J Anaesth. 1998 Dec;45(12):1168-75. PubMed
• 27. Alon E, Schulthess G, Axhausen C, Hossli G. A doubleblind comparison of tramadol and buprenorphine in the control of postoperative pain. Anaesthesist. 1981 Dec;30(12):623-6. PubMed
• 28. Magrini M, Rivolta G, Bolis C, Furiosi D. Analgesic activity of tramadol and pentazocine in postoperative pain. Int J Clin Pharmacol Res. 1998;18(2):87-92. PubMed
• 29. Richter W, von Arnim B, Giertz H. Double-blind clinical trial of tramadol capsules. First communication: Comparison with pentazocine and placebo. MMW Munch Med Wochenschr. 1981 Mar 27;123(13):517-20. PubMed
• 30. Courtney MJ, Cabraal D. Tramadol vs. diclofenac for posttonsillectomy analgesia. Arch Otolaryngol Head Neck Surg. 2001 Apr;127(4):385-8. PubMed

Published: March 31, 2008
Last updated: January 09, 2010