Scott L J, Perry C M
Adis International Limited, Auckland, New Zealand.
Drugs. 2000 Jul;60(1):139-76. doi: 10.2165/00003495-200060010-00008.
Tramadol is a synthetic, centrally acting analgesic agent with 2 distinct, synergistic mechanisms of action, acting as both a weak opioid agonist and an inhibitor of monoamine neurotransmitter reuptake. The 2 enantiomers of racemic tramadol function in a complementary manner to enhance the analgesic efficacy and improve the tolerability profile of tramadol. In several comparative, well designed studies, oral and parenteral tramadol effectively relieved moderate to severe postoperative pain associated with surgery. Its overall analgesic efficacy was similar to that of morphine or alfentanil and superior to that of pentazocine. Tramadol provided effective analgesia in children and in adults for both inpatient and day surgery. Tramadol was generally well tolerated in clinical trials. The most common adverse events (incidence of 1.6 to 6.1%) were nausea, dizziness, drowsiness, sweating, vomiting and dry mouth. Importantly, unlike other opioids, tramadol has no clinically relevant effects on respiratory or cardiovascular parameters at recommended doses in adults or children. Tramadol also has a low potential for abuse or dependence.
The efficacy of tramadol for the management of moderate to severe postoperative pain has been demonstrated in both inpatients and day surgery patients. Most importantly, unlike other opioids, tramadol has no clinically relevant effects on respiratory or cardiovascular parameters. Tramadol may prove particularly useful in patients with poor cardiopulmonary function, including the elderly, the obese and smokers, in patients with impaired hepatic or renal function, and in patients in whom nonsteroidal anti-inflammatory drugs are not recommended or need to be used with caution. Parenteral or oral tramadol has proved to be an effective and well tolerated analgesic agent in the perioperative setting.
曲马多是一种合成的中枢性镇痛药，具有两种不同的协同作用机制，既是一种弱阿片类激动剂，又是单胺神经递质再摄取抑制剂。消旋曲马多的两种对映体以互补方式发挥作用，以增强镇痛效果并改善曲马多的耐受性。在几项设计良好的对比研究中，口服和注射用曲马多可有效缓解与手术相关的中度至重度术后疼痛。其总体镇痛效果与吗啡或阿芬太尼相似，优于喷他佐辛。曲马多在儿童和成人的住院手术和日间手术中均提供有效的镇痛作用。曲马多在临床试验中通常耐受性良好。最常见的不良事件（发生率为1.6%至6.1%）为恶心、头晕、嗜睡、出汗、呕吐和口干。重要的是，与其他阿片类药物不同，曲马多在成人或儿童的推荐剂量下对呼吸或心血管参数无临床相关影响。曲马多的滥用或成瘾可能性也较低。
曲马多治疗中度至重度术后疼痛的疗效已在住院患者和日间手术患者中得到证实。最重要的是，与其他阿片类药物不同，曲马多对呼吸或心血管参数无临床相关影响。曲马多可能对心肺功能较差的患者（包括老年人、肥胖者和吸烟者）、肝肾功能受损的患者以及不推荐使用或需谨慎使用非甾体抗炎药的患者特别有用。注射用或口服曲马多已被证明是围手术期一种有效且耐受性良好的镇痛药。
