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VOLUME 13 , ISSUE 3 ( May-June, 2012 ) > List of Articles


Analgesic Efficacy of Tramadol and Butorphanol in Mandibular Third Molar Surgery: A Comparative Study

Syed Sirajul Hassan, Anees Ahmed, Manjunath Rai, TM Kalappa

Citation Information : Hassan SS, Ahmed A, Rai M, Kalappa T. Analgesic Efficacy of Tramadol and Butorphanol in Mandibular Third Molar Surgery: A Comparative Study. J Contemp Dent Pract 2012; 13 (3):364-370.

DOI: 10.5005/jp-journals-10024-1152

License: CC BY-NC 3.0

Published Online: 01-01-2010

Copyright Statement:  Copyright © 2012; The Author(s).



Butorphanol tartrate, a mixed synthetic agonistantagonist opioid analgesic has been used for management of postoperative pain in minor and major surgical procedures.14,20 Tramadol hydrochloride is a centrally acting opioid which is effectively used in postoperative pain in various minor and major surgeries.

Materials and methods

Twenty subjects selected randomly received butorphanol tartrate 1 mg intramuscular and 20 subjects received tramadol hydrochloride 50 mg intramuscular after the removal of mandibular third molars. Time of injection, amount of anesthetic injected, duration of surgery, adverse effects were recorded.21


The mean amount of LA administered in butorphanol group was 2.6450 ml and in tramadol group was 2.640 ml respectively, the mean duration for surgery was 56.75 and 53.5 minutes for butorphanol and tramadol groups respectively which was statistically not significant. Pain assessment was done with VAS which showed mean of 19.2 and 15.5 mm (p = 0.001) which was significant for butorphanol and tramadol respectively after 12 hours. The mean time for rescue medication requirement was 5.9 hours (for tramadol) and 8.4 hours (for butorphanol). Effective analgesic activity was seen by butorphanol 1 mg intramuscular then tramadol 50 mg.


Butorphanol 1 mg was more effective than tramadol 50 mg in respect to postoperative analgesia.

How to cite this article

Hassan SS, Ahmed A, Rai M, Kalappa TM. Analgesic Efficacy of Tramadol and Butorphanol in Mandibular Third Molar Surgery: A Comparative Study. J Contemp Dent Pract 2012;13(3):364-370.

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  1. Comparison of local anaesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth 2003;90:320-22.
  2. Useful adjuvants for postoperative pain management. Best Pract Res Clin Anaesth 2007;21:31-49.
  3. Local anesthesia and pain control in dental practice, St Louis, Mosby 1990;7:99.
  4. Transnasal butorphanol is effective for postoperative pain relief in children undergoing myringotomy. Anesthesiology 1998;89:385-90.
  5. A comparison of the pharmacokinetics, clinical efficacy, and tolerability of once-daily tramadol tablets with normal release tramadol capsules. J Pain Symptom Manage 2003;25:142-14.
  6. Bedford OH: Bedford Laboratories 2001.
  7. Pharmacology of systemic analgesics. Best Pract Res Clin Anesth 2002;16:475-88.
  8. Parenteral sustained-release dosage forms of butorphanol for dogs. Int J Pharmaceutics 1999;176:147-56.
  9. Manual of local anesthesia in dentistry. Jaypee 2006:3-5.
  10. The effect of tramadol on dento-alveolar surgical pain. Br J Oral Maxillofac Surg 1997;35:54-58.
  11. Pharmacokinetics of butorphanol tartrate administered from single-dose intranasal sprayer. Am J Health Syst Pharm 2004;61:261-66.
  12. An examination of the interactions between the antinociceptive effects of morphine and various mu-opioids: The role of intrinsic efficacy and stimulus intensity. Anesth Analg 1999;88:407-13.
  13. Transnasal Butorphanol for the treatment of opioid-induced pruritus unresponsive to antihistamines. J Pain Symptom Manage 1996;12:255-60.
  14. Evaluation of patient controlled remifentanil application in third molar surgery. J Oral Maxillofac Surg 2005;63:457-63.
  15. Preemptive and postoperative analgesia for dentoalveolar surgery. Oral Maxillofac Surg Clin N Am 2002 (14):137-51.
  16. A double-blind placebo-controlled comparison of tramadol/acetaminophen and tramadol in patients with postoperative dental pain. Pain 2004;109:250-25.
  17. J Wright and Sons 1990;chapter 5:132-36.
  18. The efficacy of preemptive tramadol in orthopedic day surgery. Ambu Surg 2004;11:7-9.
  19. Nonsteroidal anti-inflammatory drugs and opioids: Safety and usage concerns in the differential treatment of postoperative orofacial pain. J Oral Maxillofac Surg 2000;58:8-11.
  20. Butorphanol as a dental premedication in the mentally retarded. Oral Surg Oral Med Oral Path 1987;63:403-07.
  21. Comparison of butorphanol nasal spray and fiorinal with codeine in the treatment of migraine. Headache 1998;38:516-22.
  22. Guidelines for anxiety control and pain management in oral and maxillofacial surgery. J Oral Maxillofac 2000;58:4-7.
  23. Onset of analgesia and analgesic efficacy of tramadol/acetaminophen and codeine/acetaminophen/ibuprofen in acute postoperative pain: A single control, single dose, randomized, active controlled, parallel group study in a dental surgery pain model. Clin Therap 2004;26:1037-45.
  24. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 2001;87(1):62-72.
  25. Textbook of oral and maxillofacial surgery (6th ed), Jaypee brothers 1990;chapter 6: 83-87.
  26. Tramadol: A review of its use in perioperative pain. Drugs 2000;60(1):139-76.
  27. A risk-benefit assessment of tramadol in the management of pain. Brug Safety 1996;15(1):8-29.
  28. Effectiveness of Stadol NS (butorphanol tartrate) with ibuprofen in the treatment of pain after laserassisted uvulopalatopharyngoplasty. J Oral Maxillofac Surg 2000;58(Suppl 2):27-31.
  29. An open label evaluation of the efficacy and safety of stadol (butorphanol) NS with ibuprofen in the treatment of pain after removal of impacted wisdom tooth. J Oral Maxillofac Surg 2000;58:15-18.
  30. Pain as the 5th vital sign. J Intraven Nurs 2001;24:85-94.
  31. Postoperative analgesia. Best Clin Anaesth 1999;13:465-76.
  32. Preoperative intravenous tramadol versus ketoralac for preventing postoperative pain after third molar surgery. Int J Oral Maxillofac Surg 2004;33:274-78.
  33. Patient pain and anxiety: The medical and psychologic challenges facing maxillofacial surgery. J Oral Maxillofac Surg 2000;58:1-3.
  34. Analgesic efficacy of intranasal butorphanol in the treatment of pain after dental impaction surgery. J Oral Maxillofac Surg 2000;58:19-26.
  35. The effects of tramadol added to articaine on anesthesia duration. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:614-17.
  36. Butorphanol/diazepam compared to meperidine/diazepam for sedation in oral and maxillofacial surgery: A double-blind evaluation. Oral Surg Oral Med Oral Path 1987;64:395-401.
  37. Analgesic efficacy of peripheral opioids (all except intra-articular): A qualitative systematic review of randomized controlled trials. Pain 1997;72:309-18.
  38. Transnasal butorphanol: Patient pain relief in the head and neck patient. Otolaryngol Head Neck Surg 1997;116:197-200.
  39. The effects of tramadol and morphine on immune responses and pain after surgery in cancer patients. Anesth Analg 2000;90(6):1411-14.
  40. A double-blind, placebo-controlled study of the efficacy of a new kappa-opioid receptor agonist (R-84760) in patients with pain after dental surgery. Clin Drug Invest 2000;20(6):409-14.
  41. Pharmacokinetics of butorphanol nasal spray in patients with renal impairment. Br J Clin Pharmacol 1996;41:397-402.
  42. Do we need preemptive analgesia for the treatment of postoperative pain? Best Pract Res Clin Anaesth 2007;21:51-63.
  43. Combination tramadol plus acetaminophen for postsurgical pain. Am J Surg 2004;187:521-27.
  44. Butorphanol tartrate product information. Princeton, NJ: Bristol Myers Squibb 2002.
  45. Clinical Pharmacology of tramadol. Clin Pharmacokinet 2004;43(13):879-923.
  46. The median effective dose of tramadol and morphine for postoperative patients: A study of interactions. Anesth Analg 2005;100:469-74.
  47. Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation. Circulation 1999;99:1837-42.
  48. The absolute bioavailability and pharmacokinetics of butorphanol nasal spray in patients with hepatic impairment. Clin Pharmacol Ther 1996;60:283-94.
  49. Comparison of patient controlled analgesia (pca) with tramadol or morphine. Can J Anesth 1999;46:1030-35.
  50. Analgesic effects of intranasal butorphanol tartrate administered via a unit-dose device in the dental impaction pain model: A randomized, double-blind, and parallel-group study. Clin Ther 2005;27:430-40.
  51. Postoperative pain management and patient outcome: Time to return to work. Anesth Analg 2007;104:487-89.
  52. The effects of transnasal butorphanol on mood and psychomotor functioning in healthy volunteers. Anesth Analg 1996;82:931-35.
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