title: Pre-emptive tramadol could reduce pain after ureteroscopic lithotripsy.
abstract: OBJECTIVE
  Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones.
  
  
  METHODS
  This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement.
  
  
  RESULTS
  The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups.
  
  
  CONCLUSIONS
  Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia. anamimic@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Mimić
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia.
authors.forename: Nataša
authors.initials: N
authors.lastname: Denčić
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Jovičić
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Mirković
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Urology, Belgrade, Serbia. ; School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Otaš
authors.initials: O
authors.lastname: Durutović
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Urology, Belgrade, Serbia. ; School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragica
authors.initials: D
authors.lastname: Milenković-Petronić
authors.affiliation: Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia. ; School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Nebojša
authors.initials: N
authors.lastname: Lađević
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D010865:Pilot Projects; D014147:Tramadol / Q000008:administration & dosage* / Q000627:therapeutic use; D018666:Ureteroscopy
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol
keywords: Pre-emptive; post-operative pain; tramadol; ureteroscopic lithotripsy