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Postoperative sequelae to third-molar surgery include pain, trismus, and buccal swelling. 1 Acute inflammation, which develops as a consequence of the surgical manipulation of the hard and soft tissues, is the principal cause of these signs and symptoms. 2 Analgesics are commonly prescribed to alleviate pain induced by inflammation. 1 The analgesic agent tramadol is increasingly being used for the management of pain associated with acute and chronic inflammatory conditions. 3 4 It is neither a nonsteroidal anti-inflammatory drug (NSAID

-induced ventilatory impairment, nausea, and/or vomitting. 8 – 10 In patients undergoing maxillofacial surgeries that remodel the upper airway and extra-airway tissues, particularly when they have often undergone intermaxillary fixation, which inhibits maintenance of airway patency and proper drainage, these medications should be carefully administered with appropriate monitoring. 11 Weak opioids, such as tramadol, with or without added acetaminophen, are effective for control of dental pain, 12 but their use may be associated with nausea as an adverse effect. 13 Submucosal

substrate of CYP 2D6. 6 A notable interaction with CYP 2D6 in the postoperative period concerns the administration of analgesics for postoperative pain containing codeine or tramadol ( Figure 1 ). Both codeine and tramadol are prodrugs that require metabolism by CYP 2D6 to their active metabolites, morphine and o-desmethyltramadol, respectively. Inhibition of CYP 2D6 will reduce the amount of prodrug that is converted to active drug, resulting in inadequate analgesia. 7 , 8 The prescription of such prodrugs should be avoided in patients taking known CYP 2D6 inhibitors

attractive choice for patients having a prior history of opioid abuse because it does not provide significant euphoric effects mediated by conventional mu agonists. Tramadol Tramadol is a centrally-acting analgesic with binary action. It is not classified as a controlled substance in the United States. The parent drug inhibits the reuptake of norepinephrine and serotonin. This resembles the action of tricyclic antidepressants and potentiates descending inhibitory pathways illustrated in Figure 1 . This action has proven efficacy in the

(±20% of baseline) intraoperatively. The surgical procedure was completed in 3 hours and 16 minutes, blood loss was minimal, and the patient was extubated without difficulty while spontaneously breathing and fully awake. Acetaminophen (1000 mg) and tramadol (200 mg) were administered intravenously in the operating room after conclusion of the surgical procedure for additional postoperative analgesia. The immediate postoperative course was uneventful with no episodes of delirium or PONV. Notably antiemetics were not administered intra- or postoperatively. The patient

, constipation is unlikely. Tramadol Tramadol is a centrally acting analgesic with binary action. It is not classified as a controlled substance in the United States. The parent drug inhibits the reuptake of norepinephrine and serotonin. This resembles the action of tricyclic antidepressants and potentiates descending neural pathways that inhibit incoming nociceptive impulses. This action has proven efficacy in the management of chronic pain. However, any benefit for tramadol in acute postoperative pain management is not as well

), nonsteroidal anti-inflammatories (NSAIDs), and opioid analgesics. 6 , 7 Dexamethasone and methylprednisolone are the most commonly used corticosteroids for preemptive analgesia. 7 NSAIDs, such as diclofenac and ibuprofen, 8 , 9 and central-acting analgesics, such as tramadol, 10 , 11 have also been studied when used preemptively in surgical procedures involving third molars. The effectiveness of preemptive analgesia with the use of corticosteroids and NSAIDs has been demonstrated in previous studies that used either a placebo or different doses of the

minutes vs 37 minutes for dexmedetomidine and 54 minutes for ketamine). Hemodynamic variables, such as HR and MAP, were more stable and remained closer to baseline values in the admixture group compared with those receiving dexmedetomidine (lower HR and MAP) or ketamine alone (higher HR and blood pressure). Zor et al 17 reported similar efficacy for an IM KD admixture in adult patients requiring burn dressing changes. In this study, 24 patients were randomly assigned to receive IM ketamine alone (2 mg/kg); IM tramadol (1 mg/kg), ketamine (2 mg/kg), and