title: Tramadol and beta-cyclodextrin piroxicam: effective multimodal balanced analgesia for the intra- and postoperative period.
abstract: OBJECTIVE
  This study was conducted to evaluate the analgesic efficacy of tramadol, an analgesic with both opioid and nonopioid actions (norepinephrine and serotonin pathways), with beta-cyclodextrin piroxicam, a nonsteroidal antiinflammatory drug, in the perioperative setting.
  
  
  METHODS
  The study population consisted of 48 patients scheduled for minor abdominal procedures, who were assigned to one of four groups of 12 patients each. The premedication was either a placebo tablet or a 192.1-mg beta-cyclodextrin piroxicam tablet, administered orally 30-40 minutes before anesthesia induction. After intravenous administration of tramadol 1.5 mg/kg, anesthesia was induced with an intravenous loading dose of propofol. Anesthesia was maintained an intravenous infusion of propofol at 6-12 mg/kg/h plus either saline or tramadol at 1.2 mg/kg/h, atracurium, and a 2:1 nitrous oxide-oxygen mixture. The control group received a placebo tablet and an infusion of saline with propofol for anesthesia maintenance; the tramadol group received a placebo tablet and a continuous tramadol-propofol infusion; the beta-cyclodextrin piroxicam (BCP) group received a BCP tablet and a continuous saline-propofol infusion; and the beta-cyclodextrin piroxicam-tramadol (BCPT) group received beta-cyclodextrin piroxicam and a continuous tramadol-propofol infusion.
  
  
  RESULTS
  The relative propofol consumption by the four groups was control = BCP (P > .05) >tramadol (P < .001) > B-CPT (P < .0002). The time for analgesic rescue decreased in the order BCPT > BCP (P < .0002) = tramadol > control (P < .001). The degree of sedation and the visual analog scores 10-cm scale at the time patients requested rescue analgesics were similar among the groups (P > .05).
  
  
  CONCLUSIONS
  The combination of tramadol and beta-cyclodextrin piroxicam provided better perioperative analgesia than tramadol alone.
authors.affiliation: Department of Surgical Orthopedics and Traumatology, Hospital das Clinicas Faculty of Medicina Ribeirão Preto-USP, São Paulo, Brazil.
authors.forename: G R
authors.initials: GR
authors.lastname: Lauretti
authors.forename: A L
authors.initials: AL
authors.lastname: Mattos
authors.forename: I C
authors.initials: IC
authors.lastname: Lima
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D003505:Cyclodextrins; D004311:Double-Blind Method; D004338:Drug Combinations; D005079:Excipients; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010894:Piroxicam / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D014147:Tramadol / Q000008:administration & dosage / Q000627:therapeutic use*; D047392:beta-Cyclodextrins
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D003505:Cyclodextrins; D004338:Drug Combinations; D005079:Excipients; D047392:beta-Cyclodextrins; D010894:Piroxicam; D014147:Tramadol; C031215:betadex