title: A comparison of the effects of midazolam/fentanyl and midazolam/tramadol for conscious intravenous sedation during third molar extraction.
abstract: OBJECTIVE
  This study evaluated the effects of fentanyl and tramadol, used in combination, as sedation for third molar surgical extraction.
  
  
  METHODS
  This prospective, randomized, double-blind, placebo-controlled study included 60 patients undergoing extraction of a horizontal third molar with an Amsterdam Preoperative Anxiety and Information Scale score above 10 points. All of the patients were first given a 0.03-mg/kg bolus of midazolam, and then they were randomized into 3 groups: group A, midazolam only; group B, midazolam and 1-μg/kg fentanyl; and group C, midazolam and 1-mg/kg tramadol. The vital signs were recorded. Patients were assessed for postoperative pain and adverse effects, and patient and surgeon satisfaction was assessed.
  
  
  RESULTS
  No differences were found in the heart rate among groups (P > .05). The mean blood pressure was also similar until the 40th minute, after which the mean blood pressure in the patients in group A was lower than that in the other 2 groups (P < .01). In the postoperative pain assessment, the visual analog scale scores of the patients in group C were lower than those in the other 2 groups in the first postoperative hour (P < .05). The time at which the first rescue analgesic was taken in groups A, B, and C was 3, 3.5, and 5 hours postoperatively, respectively, and was significantly later in group C (P < .01). No difference was found in patient/surgeon satisfaction among the groups.
  
  
  CONCLUSIONS
  Tramadol has a better analgesic effect in third molar surgery than fentanyl and placebo.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Marmara University, Istanbul, Turkey.
authors.forename: Ozgen
authors.initials: O
authors.lastname: Göktay
authors.forename: Tülin
authors.initials: T
authors.lastname: Satilmiş
authors.forename: Hasan
authors.initials: H
authors.lastname: Garip
authors.forename: Onur
authors.initials: O
authors.lastname: Gönül
authors.forename: Kamil
authors.initials: K
authors.lastname: Göker
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000766:Anesthesia, Dental; D019162:Anesthetics, Combined; D016292:Procedural Sedation; D004311:Double-Blind Method; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D008964:Molar, Third / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain; D017060:Patient Satisfaction; D014081:Tooth Extraction; D014095:Tooth, Impacted / Q000601:surgery; D014147:Tramadol / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D006993:Hypnotics and Sedatives; D014147:Tramadol; D008874:Midazolam; D005283:Fentanyl