Analgesic efficacy and safety of Tramadol ( Generic Ultram )/ acetaminophen combination tablets (Ultracet) in treatment of chronic low back pain: a multicenter, outpatient, randomized, double blind, placebo controlled trial.Peloso PM, Fortin L, Beaulieu A, Kamin M, Rosenthal N; Protocol TRP-CAN-1 Study Group.Division of Rheumatology, Roy and Lucille Carver College of Medicine, University of Iowa Health Care E330 GH, 200 Hawkins Drive, Iowa City, IA 52242, USA. OBJECTIVE: To evaluate the analgesic efficacy and safety of Tramadol ( Generic Ultram ) 37.5 mg/acetaminophen 325 mg (Tramadol ( Generic Ultram )/APAP) combination tablets for treatment of chronic low back pain (LBP). METHODS: This 91 day, multicenter, outpatient, randomized, double blind, placebo controlled study enrolled 338 patients with chronic LBP requiring daily medication for > or = 3 months. Patients with at least moderate pain [pain visual analog scale (VAS) with scores > or = 40/100 mm] after washout were randomized to Tramadol ( Generic Ultram )/APAP or placebo. After a 10 day titration, patients received 1 or 2 tablets QID. Primary outcome measure was final pain VAS score. Secondary measures included pain relief, quality of life and physical functioning, efficacy failure, and overall medication assessments. RESULTS: In total, 336 intent-to-treat patients received Tramadol ( Generic Ultram )/APAP (n = 167) or placebo (n = 169). Mean baseline pain VAS score was 67.8. Intent-to-treat analysis showed significantly better mean final pain VAS scores (47.4 vs 62.9; p < 0.001) and mean final pain relief scores (1.8 vs 0.7; p < 0.001) for Tramadol ( Generic Ultram )/APAP than for placebo. Roland Disability Questionnaire scores and physical-related subcategories of the McGill Pain Questionnaire and the Medical Outcome Study Short Form-36 Health Survey were significantly better for Tramadol ( Generic Ultram )/APAP patients. More patients rated Tramadol ( Generic Ultram )/APAP as "very good" or "good" than placebo (63.6 vs 25.2%; p < 0.001). Kaplan-Meier estimates of cumulative discontinuation rates due to efficacy failures were 22.9% (Tramadol ( Generic Ultram )/APAP) vs 54.7% (placebo; p < 0.001). The most common treatment related adverse events with Tramadol ( Generic Ultram )/APAP were nausea (12.0%), dizziness (10.8%), and constipation (10.2%). Average daily dose of Tramadol ( Generic Ultram )/APAP was 4.2 tablets (Tramadol ( Generic Ultram ) 158 mg/APAP 1369 mg). CONCLUSION: Tramadol ( Generic Ultram ) 37.5 mg/APAP 325 mg combination tablets show efficacy in pain reduction, in measures of physical functioning and quality of life, and in overall medication assessments, with a tolerability profile comparable with other opioids used for the treatment of chronic LBP.

Laparoscopic donor nephrectomy (LD) is rapidly gaining popularity, however, this may not be affordable by donors in many developing countries because of its high cost. We describe our mini flank incision (MD) donor nephrectomy technique and its outcome. METHODS: A 7-10-cm subcostal rib sparing transverse incision was given 2 cm lateral to the tip of the 12th rib, towards the lateral border of rectus muscle. All dissections were performed with help of long retractors and instruments, vessels were transfixed and cut. In last 45 cases, vessels were clipped with Liga or Weck clips. Donors and recipients outcome was analysed. RESULT: From January 2000 to December 2002 a total of 148 patients underwent donor nephrectomy by mini incision technique. Mean patient age was 44.8 +/- 7.3 yr (range 20-70 yr). Nephrectomies were performed in 115 patients on the left side and in 33 cases on the right side. The mean incision length was 9.1 +/- 1.8 cm (range 7-10 cm). Mean operative time was 105 +/- 10.5 min (70-130 min). Mean analgesic (Tramadol ( Generic Ultram )) requirement was 205 +/- 52 mg; postoperative hospital stay was 2.2 +/- 0.5 d. Twelve per cent patients developed fever and 4% had superficial wound infection in postoperative period. Three patients required blood transfusion. Mean convalescence period was 22 +/- 2.8 d. CONCLUSION: Extrapleural, extraperitoneal, subcostal mini incisions live donor nephrectomy is a relatively safe procedure with low morbidity. This technique has a shorter hospital stay, early convalescence and better cosmesis. It is cost-effective and is an ideal substitute for the developing country.

Muscle rigidity induced by the opioid analgesic Tramadol ( Generic Ultram ), but not by the non-opioid flupirtine.

The influence of high doses of two analgesic drugs, Tramadol ( Generic Ultram ) and flupirtine on the electromyographic activity in the gastrocnemius soleus muscles was examined. Tramadol ( Generic Ultram ) (100-200 mg/kg po) dose-dependently induced a tonic electromyographic activity, which is generally accepted as a model of the opiate-induced muscle rigidity. That effect was antagonized by intraperitoneal injection of naloxone (0.8 mg/kg ip). On the other hand, flupirtine even in the high doses (100-200 mg/kg po) did not induce any tonic electromyographic activity. The obtained results confirm an opiate-like action of Tramadol ( Generic Ultram ), but not that of flupirtine, on the muscle tension.

Postoperative patient-controlled analgesia with intravenous Tramadol ( Generic Ultram ), intravenous fentanyl, epidural Tramadol ( Generic Ultram ) and epidural ropivacaine+fentanyl combination.Aygun S, Kocoglu H, Goksu S, Karaca M, Oner U.Department of Anaesthesiology and Reanimation, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.PURPOSE: The aim of this study was to compare the effects of IV Tramadol ( Generic Ultram ), IV fentanyl, epidural Tramadol ( Generic Ultram ), and an epidural ropivacaine+fentanyl combination in patient-controlled analgesia (PCA) after lower abdominal surgery. METHODS: Eighty adult patients undergoing lower abdominal surgery were randomly allocated to one of four groups to receive analgesics with PCA pumps. Patients in group I received IV Tramadol ( Generic Ultram ), group II patients IV fentanyl, group III patients epidural Tramadol ( Generic Ultram ), and group IV patients an epidural infusion of 0.125% ropivacaine + 2 microg ml(-1) fentanyl combination. Analgesic effectiveness and side-effects were assessed at 1, 2, 3, 4, 5, 6, 8, 12, 16, 20, and 24 hours after surgery. RESULTS: Adequate analgesia was achieved in all groups. The analgesia was highest in group IV (p < 0.05), and lowest in group III patients (p < 0.05). Eleven patients (55%) in group I and eight patients (40%) in group II suffered from nausea/vomiting. CONCLUSION: Although adequate pain relief was achieved with all regimens that were used in the study, intravenous Tramadol ( Generic Ultram ) and intravenous fentanyl are associated with a high incidence of nausea and vomiting.