Risk factors for adverse events in patients administered intravenous tramadol hydrochloride in Emergency Department

INTRODUCTION: The aim of the present study was to assess the adverse events developing in patients treating with intravenous(iv) tramadol to provide moderate to severe pain control in emergency department (ED) and to investigate the association of these adverse events with age, sex and vital signs and to compose a set of rules for the identification of patients in the risk group.  MATERIAL AND METHODS: In this prospective cohort study, patients older than 18 years, admitted to ED during a 1-year period and administered iv tramadol were included in a secondary care public hospital. Information about age, sex, vital signs and adverse events were recorded. Patients defined as group 1 or group 2 with respect to adverse event development status and the groups were compared in terms of age, sex and vital signs.  RESULTS: A total of 408 patients were included in the study. Adverse events ratio after treatment was 21.1%. Adverse events were nausea, dizziness and vomiting. The age and the pulse rate per minute of the patients in group 1 were found to be higher and systolic blood pressure (SBP) was found to be lower than the patients in group 2.  CONCLUSIONS: The risk of adverse events development is higher in patients who are hypotensive, tachycardic and older than 56 years. Multicenter, prospective studies with larger patient groups are needed to support our results.

[1]  G. Lavigne,et al.  Impact of age, sex and route of administration on adverse events after opioid treatment in the emergency department: A retrospective study , 2015, Pain research & management.

[2]  M. Cudnik,et al.  The effectiveness and adverse events of morphine versus fentanyl on a physician-staffed helicopter. , 2012, The Journal of emergency medicine.

[3]  K. Hamunen,et al.  Parenteral opioids in emergency medicine – A systematic review of efficacy and safety , 2011, Scandinavian journal of pain.

[4]  P. Bijur,et al.  Randomized clinical trial comparing the safety and efficacy of a hydromorphone titration protocol to usual care in the management of adult emergency department patients with acute severe pain. , 2011, Annals of emergency medicine.

[5]  E. Kalso,et al.  Management of pain in a surgical emergency unit—Underlying factors affecting its delivery , 2008 .

[6]  P. Bijur,et al.  Response to Morphine in Male and Female Patients: Analgesia and Adverse Events , 2008, The Clinical journal of pain.

[7]  R. Barkin.  Extended-release Tramadol (ULTRAM ER): a pharmacotherapeutic, pharmacokinetic, and pharmacodynamic focus on effectiveness and safety in patients with chronic/persistent pain. , 2008, American journal of therapeutics.

[8]  Jonathan F. Borus,et al.  Somatic symptom reporting in women and men , 2001, Journal of General Internal Medicine.

[9]  Christopher L. Wu,et al.  Effect of Postoperative Epidural Analgesia on Morbidity and Mortality Following Surgery in Medicare Patients , 2004, Regional Anesthesia & Pain Medicine.

[10]  J. Farrar,et al.  Side effects of opioids during short‐term administration: Effect of age, gender, and race , 2003, Clinical pharmacology and therapeutics.

[11]  M. Tsai,et al.  Pain Management in the Emergency Department , 2002 .

[12]  L. Zun,et al.  Gender differences in narcotic-induced emesis in the ED. , 2002, The American journal of emergency medicine.

[13]  W. Cordell,et al.  The high prevalence of pain in emergency medical care. , 2002, The American journal of emergency medicine.

[14]  Christopher L. Wu,et al.  Measurement of Patient Satisfaction as an Outcome of Regional Anesthesia and Analgesia: A Systematic Review , 2000, Regional Anesthesia & Pain Medicine.

[15]  S. Schug.  Patient Satisfaction-Politically Correct Fashion of the Nineties or a Valuable Measure of Outcome? , 2000, Regional Anesthesia & Pain Medicine.