ABSTRACT
Aim:
This study was intended to assess and relate the clinical anesthetic effectiveness of tramadol hydrochloride and lidocaine.
Methodology:
A clinical randomized split-mouth study was piloted among 40 patients who were otherwise healthy but needed to have their maxillary first premolars extracted bilaterally for orthodontic reasons were considered in the research. In each subject on one side (quadrant) of the arch 1.8 milliliters of lidocaine was given and on other side of the arch 1.8 milliliters of tramadol was given. On the basis of a list that was prepared by a computer, the randomization was done and the sides (quadrant) of the arches were decided for all the subjects, and the injections were given as local infiltration.
Results:
Lidocaine was found to be statistically more effective for overall anesthesia duration, despite the fact that there was no significant variance between the two drugs at the time when anesthetic effect began to take effect. Tramadol was found to be statistically more efficient than lidocaine when compared to the anesthetic activity at the 5th minute before extraction. Tramadol was found to be statistically more successful than lidocaine for both the patient’s degree of satisfaction and the rate at which wounds healed.
Conclusion:
Based on the findings of this research, it appears that tramadol and epinephrine could be used as a substitute to conventional local anesthetics during extractions of maxillary first premolar teeth during oral-maxillofacial surgery.
KEYWORDS: Anesthetic, efficacy, extraction, lidocaine, tramadol
INTRODUCTION
Even though preventive dentistry has gained greater popularity, extraction of the teeth is still the most common surgical procedures in dentistry.[1] Extraction of symmetrical maxillary or mandibular premolar teeth, for instance, is an example of one of these space-saving therapies. Other examples include other dental procedures. Dentistry makes extensive use of local anesthetics, which momentarily block nerve conduction but does not have an effect on the patient’s consciousness. These anesthetics are extensively utilized to alleviate patients’ concerns over pain.[2] In spite of the fact that a number of different local anesthetics have been shown to be effective in a number of studies, some patients may still experience intraoperative or postoperative pain.[3] So, the question of which anesthetic agent is the most effective is still a contentious one, and there is no clear consensus regarding this problem to this day. As a result of this, one of the most common areas of inquiry in the field of dentistry, specifically with tooth extraction, is the quest for the most efficient anesthetic agent.[4] Opioids like tramadol have recently been demonstrated to have local anesthetic effects in addition to their analgesic qualities, which were discovered through research conducted in-vitro and in-vivo.[5] Nonetheless, additional research on the effectiveness of tramadol in oral surgery is still required.[6]
MATERIAL AND METHODS
The total number of patients was determined to be 32 patients with an actual power of 0.85 when the significance threshold was accepted as 0.05 (two tailed), effect size 0.55, and target power 0.85. Consequently, 50 (including all the drop-outs) systemically healthy participants who were over 18 years old and of both sexes were included in the study. For data analysis, SPSS 25 (SPSS, Inc., Chicago, IL) was utilized. The Kolmogorov-Smirnov and Shapiro-Wilk tests were applied to define whether the data had a normal distribution (P < 0.05). Mann–Whitney U test was applied to analyze data with an irregular distribution. For the purpose of comparing the sensory innervation values, the marginal homogeneity test was run. The Chi-square test was used to examine the anesthetic agents’ satisfaction ratings.
RESULTS
In all subjects, tooth extractions were completed with just one buccal injection. None of the subjects required repeated buccal or extra palatal injections, and none experienced any palate pain. Table 1 lists the male to female ratio and surgical patient characteristics. With lidocaine and tramadol, the mean times for the onset of anesthesia were 37.69 ± 21.25 and 42.51 ± 28.28 seconds, respectively. This time span was 10–116 seconds in the lidocaine group and 5–113 seconds in the tramadol group with no statistical variance between the two groups [Table 2]. The mean length of 230.23 ± 58.12 minutes for the lidocaine group. The mean time in the tramadol group was 149.21 ± 78.36 minutes. Tramadol and lidocaine were statistically considerably less effective than each other in terms of the total duration of anesthesia P = 0.001 [Table 1]. Following the surgery, a 5-point scale was used to assess patient satisfaction and wound healing. In both factors, there was a statistically significant variance between the groups. The tramadol group’s satisfaction scores and wound healing rate were statistically higher than the lidocaine subjects. Subjects reported that the area where tramadol was treated was more effective than the area where lidocaine was applied (P = 0.002) [Table 2]. The postoperative pain score was calculated using a VAS scale with a maximum of 10. When compared to the tramadol group, pain values following extraction were substantially higher in the lidocaine group at hours 7, 8, 9, and 10 (P < 0.05) [Table 3].
Table 1.
Association of onset, duration of action among the groups
| Parameter | Lidocaine (n=50) | Tramadol (n=50) | P |
|---|---|---|---|
| Onset of Anesthesia (s) | 37.69±21.25 | 42.51±28.28 | 0.457 |
| Duration (min) | 230.23±58.12 | 149.21±78.36 | 0.001 |
Table 2.
Wound healing and satisfaction rates post-extraction
| Bad | Reasonable | Good | Very good | Excellent | |
|---|---|---|---|---|---|
| Satisfaction Levels | |||||
| L | 0 | 4 | 10 | 30 | 6 |
| T | 0 | 0 | 6 | 20 | 24 |
| Wound Healing | |||||
| L | 0 | 8 | 28 | 14 | 0 |
| T | 0 | 2 | 20 | 28 | 0 |
L - Lidocaine; T - Tramadol
Table 3.
Comparison of postoperative VAS score in lidocaine and tramadol groups
| 7 h | 8 h | 9 h | 10 h | ||||
|---|---|---|---|---|---|---|---|
|
|
|
|
|
||||
| L | T | L | T | L | T | L | T |
| 1.21±1.62 | 0.36±0.54 | 1.01±1.25 | 0.37±1.25 | 0.87±1.51 | 0.46±1.45 | 0.71±1.12 | 0.32±1.57 |
| P=0.02 | P=0.024 | P=0.031 | P=0.041 | ||||
L - Lidocaine; T - Tramadol
DISCUSSION
Two commonly used anesthetic agents are evaluated in current research. Many studies compared tramadol’s analgesic effectiveness to that of various NSAIDs. Preoperative tramadol was found to have equal analgesic effects in some of these investigations, however in others, it was claimed that NSAIDs were more effective.[7,8] It must be stressed, nonetheless, that tramadol works best as an analgesic when combined with NSAIDs.[9] The atypical opioid tramadol targets the mu receptors only. Dentistry has also looked at the effects of tramadol anesthesia, and the impact of submucosal tramadol addition on the length of local anesthetic was examined. In oral procedures such as tooth extraction and periapical surgery, according to Al-Haideri,[10] only one of the 50 patients in the tramadol and adrenaline combo group had nausea and vomiting, whereas three patients in the pure tramadol group did. In a similar way, a study observed that just 1 patient had dizziness in the lidocaine group while 3 patients experienced nausea and dizziness among a group of 50 patients receiving the epinephrine-free tramadol.[11] These investigations all demonstrated that there is no discernible difference in the negative effects. All these side effects were noted in both groups in the current trial, but there was no discernible difference between the groups in terms of side effects. Both medications seem to be well tolerated by patients. Al-Haideri studies 10 did not mention the level of patient satisfaction with respect to the anesthetic agents used. Yet, there was a statistically significant variance in the groups’ levels of satisfaction and wound healing in the current study. Patients found the tramadol group’s treatment to be less effective than that of the lidocaine group in terms of both metrics. The fact that the trial did not involve any type of surgery or the addition of epinephrine, may be the reason for the discrepancy between the two investigations.[12] Our study shows that administering tramadol to the surgical site during dental surgical procedures is beneficial.
CONCLUSION
Tramadol delivered submucosally has been shown to have an efficient anesthetic action in infiltration anesthesia in addition to its analgesic impact, particularly when combined with epinephrine. In this regard, patients having oral and maxillofacial surgery may use tramadol as a dependable, secure, and efficient alternative agent for local infiltrative anesthetic. Additionally, we believe that it can enhance surgical procedures in a variety of ways because of its potential intraoperative and postoperative anesthetic and analgesic effects.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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