title: Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery.
abstract: BACKGROUND
  This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics.
  
  
  METHODS
  In a randomized, controlled, single-blinded procedure, 87 men and women aged 18-44 years were divided into two treatment groups, midazolam + tramadol (M + T) and midazolam + saline (M + S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery.
  
  
  RESULTS
  Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M + S group (193 min) and the C group (110 min) (p = 0.001) as well as the M + T group (157 min) and the C group (p = 0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation.
  
  
  CONCLUSIONS
  The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.
authors.affiliation: Department of Oral and Maxillofacial Surgery, County Hospital, Falu Lasarett, Sweden. lars.b.eriksson@ltdalarna.se
authors.forename: Lars
authors.initials: L
authors.lastname: Eriksson
authors.forename: Ake
authors.initials: A
authors.lastname: Tegelberg
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016292:Procedural Sedation; D049668:History, 15th Century; D049669:History, 16th Century; D006801:Humans; D006993:Hypnotics and Sedatives; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam; D008964:Molar, Third / Q000601:surgery*; D010147:Pain Measurement / Q000187:drug effects*; D010149:Postoperative Pain / Q000517:prevention & control*; D011229:Preanesthetic Medication; D016037:Single-Blind Method; D014081:Tooth Extraction / Q000523:psychology*; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D014147:Tramadol; D008874:Midazolam