title: Local infiltrative anesthetic effect of tramadol compared to lidocaine for excision of cutaneous lesions: pilot randomized, double-blind clinical study.
abstract: BACKGROUND
  In this double-blind, randomized study, the efficacy of tramadol, an atypical opioid, was tested versus lidocaine in excision of cutaneous lesions of the face.
  
  
  METHODS
  Eighty-eight patients were randomly assigned to receive either 2 mg/kg tramadol 2% plus adrenaline 1:200,000 (group T, n  =  46) or 3 mg/kg lidocaine 2% plus adrenaline 1:200,000 (group L, n  =  42) for excision of cutaneous lesions. Pain at the injection site, 2 and 20 minutes postinjection and 3, 6, and 12 hours postoperatively, was monitored on a 0 to 10 numerical rating scale (NRS). Irritation at the injection point and the duration of postoperative analgesia were also recorded.
  
  
  RESULTS
  There were no significant differences in demographic data, topography, size of the lesions removed, and operative time between the two groups. A tendency toward lower injection NRS pain scores was observed in group L compared to group T (p  =  .064). No statistically significant differences between the two groups were found at 2 and 20 minutes postinjection (p  =  .741 and p  =  .142, respectively); however, pain scores were significantly higher in group L at 3, 6, and 12 hours postoperatively (all p < .001). Erythema at the injection site was observed in nine group T and two group L patients (p  =  .076). No postoperative analgesics were required in the tramadol group of patients, whereas acetaminophen with or without codeine was administered in all but five lidocaine group patients during the first 12 hours.
  
  
  CONCLUSIONS
  Tramadol may be used as a reliable local anesthetic agent, providing longer postoperative analgesia compared to lidocaine; however, it bears a higher incidence of irritation at the injection site.
authors.affiliation: Department of Plastic Surgery, Democritus University of Thrace, Alexandroupolis, Greece. despoinakakagia@yahoo.com
authors.forename: Despoina
authors.initials: D
authors.lastname: Kakagia
authors.forename: Theodosia
authors.initials: T
authors.lastname: Vogiatzaki
authors.forename: Savvas
authors.initials: S
authors.lastname: Eleftheriadis
authors.forename: Gregory
authors.initials: G
authors.lastname: Trypsiannis
authors.forename: Christos
authors.initials: C
authors.lastname: Iatrou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005148:Facial Dermatoses / Q000601:surgery*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010865:Pilot Projects; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D008012:Lidocaine; D004837:Epinephrine