The clinical use of tramadol hydrochloride

The attributes of tramadol hydrochloride provide the clinician with a useful analgesic for short- and long-term use in the hospital and community settings. The two enantiomers of tramadol, and its principle metabolite O-desmethyltramadol, produce relief of moderate to severe pain across the range of acute and chronic pain states by combining synergistically weak opioid and monoaminergically-mediated antinociceptive mechanisms. Tramadol is demonstrably inferior to morphine in severe pain; however, it is free of some of the clinically significant adverse effects seen with other opioid analgesics of similar efficacy, particularly respiratory depression. Tramadol causes minimal dependence and tolerance and has very low abuse potential; consequently it is not scheduled as a controlled drug. Tramadol also lacks the prostaglandin inhibition-mediated adverse effects of the nonsteroidal anti-inflammatory drugs. Although data reflect 20 years of clinical experience with tramadol, intraoperative experience remains limited due to historical concerns of accidential awareness with an outdated anaesthetic technique that has been superseded.