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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 3  |  Page : 175-177

Tramadol HCL as an effective alternative to lignocaine HCL for extraction of tooth under supraperiosteal infiltration


Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Uttar Kalinagar, West Bengal, India

Date of Submission06-Sep-2020
Date of Acceptance17-Jan-2021
Date of Web Publication12-Jul-2021

Correspondence Address:
Oishee Mukherjee
Department of Oral and Maxillofacial Surgery, Haldia Institute of Dental Sciences and Research, Banbishnupur, Balughata, Uttar Kalinagar - 721 645, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_146_20

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  Abstract 


Purpose: To evaluate the efficacy of tramadol as a local anesthetic effect. Materials and Methods: Fifty patients were evaluated. Group A given tramadol and Group B given lignocaine. Parameters such as pain on injection, onset of action, duration of effect, and side effects if any were recorded. Results: None of the patients showed any allergic response to the respective drug administered. The onset of anesthesia (objective) for tramadol and lignocaine was, respectively, 165.0 ± 39.80 s and 159.60 ± 35.09 s, not statistically significant (P = 0.613). Mean duration of anesthesia for them was 47.50 ± 7.51 min for tramadol and 45.70 ± 7.10 min for lignocaine, also statistically nonsignificant (P = 0.388). Regarding intraoperative pain, mean was 0.41 ± 1.013 of tramadol and of lignocaine was 0.31 ± 0.451, P = 0.654 also being statistically nonsignificant. Two patients receiving tramadol had nausea and 1 had pain. Those receiving lignocaine, only 1 patient had pain (P = 0.214). Conclusion: Tramadol has an almost similar local anesthetic efficacy with that of lignocaine.

Keywords: Lignocaine, tramadol, extraction, local anesthesia


How to cite this article:
Basu S, Mukherjee O, Sahu S, Banerjee R, Pachisia S, Biswas A. Tramadol HCL as an effective alternative to lignocaine HCL for extraction of tooth under supraperiosteal infiltration. Indian J Dent Sci 2021;13:175-7

How to cite this URL:
Basu S, Mukherjee O, Sahu S, Banerjee R, Pachisia S, Biswas A. Tramadol HCL as an effective alternative to lignocaine HCL for extraction of tooth under supraperiosteal infiltration. Indian J Dent Sci [serial online] 2021 [cited 2021 Sep 20];13:175-7. Available from: http://www.ijds.in/text.asp?2021/13/3/175/321172




  Introduction Top


Lidocaine established in 1948 is the widely used local anesthetic agent in dentistry.[1] Voltage-gated sodium channels play a critical role in the generation and propagation of action potentials in the neurons and muscle cells. The mechanism of action of lignocaine is by stopping the sodium ions from passing through the voltage-gated channels. Tramadol is a centrally acting analgesic, synthesized in 1962 by Grunenthal GmbH in Germany. It has two mechanisms of actions, weak opioid agonist, and inhibitor of monoamine neurotransmitter receptor. This is due to the fact that there are two enantiomers of racemic tramadol.[2],[3]

Recent studies have revealed that the administration of tramadol has local anesthetic effect because of its neurotransmitter blocking effect. In 2013, Al Haideri reported that tramadol alone or in combination with adrenaline can be used as a local anesthetic for extraction of tooth under supraperiosteal infiltration.[4] Hence, we decided to conduct a study to evaluate the efficacy of Tramadol HCL versus lignocaine HCL.


  Materials and Methods Top


The study was explained to all participants in their language, and a written consent was obtained. Fifty American Society of Anesthesiologists (ASA) I patients, aged 18–40 years, both male and female participants were included. Pregnant or lactating females, medically compromised individuals and those allergic to drugs used or cases requiring multiple extractions were excluded. Each group was divided into two groups. Group A received 2 ml of 5% tramadol as a LA solution or a maximum of 2 ml of 2% lignocaine.

Every patient was injected 0.1 ml of test dose intradermally. The formation of “bleb” indicated that the injection was properly injected.

Response evaluation-the site was checked for 15–20 mins. Response was checked by change in skin diameter or wheal:[5]

Scale: 0 = No reaction, 1 = Mild rash, 2 = Erythema, and 3 = Urticarial

If there was no allergic reactions noted, then the patient was administered either 0.5 ml lignocaine or tramadol on the buccal soft tissue and 0.2 ml on the palatal tissue. Both the investigator and participant were unaware of the drug being injected. The following parameters were evaluated.

Pain

Before the initiation of the procedure, patients were explained about the Visual Analog Scale (VAS). On injecting the drug, the patient pain response was checked where 0 was no pain and 10 indicated worst pain.

Onset of anesthesia

With the help of stopwatch, the time interval was measured from the time of administration of the injection till the time the patient felt numbness on the concerned site which gave a measurement of the concerned subjective sign.

To check the objective symptom with the help of a probe after an initial 1 min, every 10 secs pain was checked with VAS.

Duration

The interval between the numbness at the site of drug delivery till the time it took for its disappearance was recorded.

Postoperative Analgesia

After 24 hours, it was checked whether there was any need of analgesics.

Side effects

Any side effects were recorded


  Results Top


Out of the total patients included in the study, 28 were male and 22 were female, mean age 28.61, standard deviation being 4.120. None of the patients showed any allergic response to the respective drug administered. The onset of anesthesia (objective) for tramadol and lignocaine was, respectively, 165.0 ± 39.80 s and 159.60 ± 35.09 s, and there was no statistically significance between them (P = 0.613) [Table 1] and [Figure 1]. Mean duration of anesthesia for them was 47.50 ± 7.51 min for tramadol and 45.70 ± 7.10 min for lignocaine, also statistically nonsignificant (P = 0.388) [Table 2] and [Figure 2]. Regarding intraoperative pain, maximum VAS score was recorded for tramadol was 3 and minimum 0, mean being 0.41 ± 1.013. That of lignocaine was 0.31 ± 0.451, P = 0.654 also being statistically nonsignificant [Table 3]. Side effects were evaluated, two patients receiving tramadol had nausea and 1 had pain, those receiving lignocaine, only 1 patient had pain.
Table 1: Comparison between two groups for onset of action (sec)

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Table 2: Comparison between two groups for duration of action (min)

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Table 3: The association of pain on injection among groups under Visual Analog Scale score (0-10)

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Figure 1: Bar chart of comparison of onset action between two groups

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Figure 2: Bar chart of comparison between two groups for duration of action (in minutes)

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  Discussion Top


Tramadol HCL acts on serotonergic and noradrenergic nociception, while its metabolite O-desmethyl tramadol acts on the μ-opioid receptor. Its analgesic potency is claimed to be about one tenth that of morphine. Tramadol is used to treat both acute and chronic pain of moderate to (moderately) severe intensity.

Tramadol exists as the racemic (1:1) mixture of the (±) and (-)-enantiomer. It has a multimodal mechanism of action as on the one hand the (±) and (-)-enantiomer act on the serotonin and noradrenaline reuptake, and on the other hand, the O-desmethyl metabolite of tramadol acts on the μ-opioid receptor. This implies that the analgesic mechanism of action of tramadol includes both nonopioid components, i.e., noradrenergic and serotonergic components and opioid components. (1) The (±)-enantiomer of tramadol contributes to analgesia by inhibiting the reuptake of serotonin, the (−)-enantiomer by inhibiting the reuptake of noradrenaline and the O-desmethyl metabolite by binding with relative high affinity (compared to tramadol) to the μ-opioid receptor.[2],[3]

In 1999, it was shown by Pang et al.[6] that tramadol was effective in reducing propofol injection pain and it was postulated that tramadol has a peripheral analgesic activity. Pang et al. was the first to report on local anesthetic efficacy of tramadol when compared with lignocaine on the surface of forearm.[7] In 2001, Tsai et al. studied the effect of tramadol when directly applied to the sciatic nerve in rats.[8]

Opioids exhibit a local anesthetic effect in the peripheral nervous system by inhibiting excitatory synaptic transmission by activating opioid receptors in the central nervous system. Conduction of action potential is hence blocked.[9]

Although Yuge et al. mentioned that there was no significant change in the amplitude of Compound Action Potentials (CAP), others reported that conduction of action potential in the peripheral nerve is generally blocked by opioids.[10] Such an inhibition on CAP by a nonnarcotic opioid tramadol was also reported. Tramadol blocks Na+ channels following a hydrophilic channel and voltage-dependent K+ channels mainly responsible for repolarization, more than lignocaine.[11]

Tramadol also showed a dose-dependent variation in nerve conduction that was fully reversible without any deleterious neurological effect.

Mert et al. reported that tramadol HCl provided a similar but weaker anesthetic effect and nerve blockade compared with lidocaine HCl.[12],[13]

In our study, it is seen that the mean onset of action of tramadol was 165 s and that of lignocaine was around 159 s and the mean duration of action being 47 and 45 min respectively both being statistically insignificant. Hence, tramadol has an almost similar anesthetic property with that of lignocaine which is considered to be the “Gold Standard” for the comparison with other drugs.[10]


  Conclusion Top


Tramadol has an almost similar local anesthetic effect with that of lignocaine, hence can be used as alternative to local anesthetic agents it can be used as an alternative to lignocaine for extraction of tooth, in situations where lignocaine cannot be used due to allergy to the particular drug and various other some unusual reason.

Ethical clearance

Ethical Clearence has been obtained.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Malamed SF. Handbook of Local Anaesthesia. 6th ed. St. Louis: Mosby; 2013.  Back to cited text no. 1
    
2.
World Health Organization. Tramadol Update Review Report; 2014. Available from: http://www.who.int/medicines/areas/quality_safety/6_1_ Update.pdf2). [Last accessed on 2020 Aug 03].  Back to cited text no. 2
    
3.
Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmamacokinet 2004;43:879-923.  Back to cited text no. 3
    
4.
Al-Haideri YA. Comparison of local anesthetic efficacy of tramadol hydrochloride (with adrenaline) versus plain tramadol hydrochloride in the extraction of upper molar teeth. J Oral Maxillofac Surg 2013;71:2035-8.  Back to cited text no. 4
    
5.
Altunkaya H, Ozer Y, Kargi E, Babuccu O. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth 2003;90:320-2.  Back to cited text no. 5
    
6.
Pang WW, Huang PY, Chang DP, Huang MH. The peripheral analgesic effect of tramadol in reducing propofol injection pain: A comparison with lidocaine. Reg Anesth Pain Med 1999;24:246-9.  Back to cited text no. 6
    
7.
Pang WW, Mok MS, Chang DP, Huang MH. Local anesthetic effect of tramadol, metoclopramide, and lidocaine following intradermal injection. Reg Anesth Pain Med 1998;23:580-3.  Back to cited text no. 7
    
8.
Tsai YC, Chang PJ, Jou IM. Direct tramadol application on sciatic nerve inhibits spinal somatosensory evoked potentials in rats. Anesth Analg 2001;92:1547-51.  Back to cited text no. 8
    
9.
Dalkilic N, Tuncer S, Bariskaner H, Kiziltan E. The effect of tramadol on the rat sciatic nerve conduction: A numerical analysis and conduction velocity distribution study. Yakugaku Zasshi 2009;129:485-93.  Back to cited text no. 9
    
10.
Alsandook TA, Haideri YA. A pilot double blinded clinical trial to compare between tramadol HCl and lidocaine HCl as local anaesthesia amongst hospital-outpatient adult dental attendees Mosul-Iraqi. J Oral Res 2013;1:13-6.  Back to cited text no. 10
    
11.
Yuge O, Matsumoto M, Kitahata LM, Collins JG, Senami M. Pain pathways and transmission. Anesth Analg 1985;64:667-71.  Back to cited text no. 11
    
12.
Mert T, Gunes Y, Guven M, Gunay I, Ozcengiz D. Blocking action of tramadol on nerve conduction. Intern J Pharmacol 2001:64;214-7.  Back to cited text no. 12
    
13.
Mert T, Gunes Y, Guven M, Gunay I, Ozcengiz D. Comparison of nerve conduction blocks by an opioid and a local anaesthetic. Eur J Pharmacol 2002;439:77-81.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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