Volume 2020 Number 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094


Pain is a leading cause of visits to any emergency department (ED) and a large percentage of it is primarily caused by musculoskeletal trauma, however there has been a lack of use of analgesia in a large proportion of these patients1. Tramadol is a common choice among emergency residents due to the rare incidence of respiratory depression during its administration, low incidence of cardiac depression, and the incidence of dizziness and drowsiness is lower than when morphine is administered2,3. We aim to determine whether subcutaneous tramadol administration has a lower incidence of adverse events and pain score associated with administration in comparison to intravenous tramadol. Single-center randomized parallel group trial of subcutaneous (S/C) versus intravenous (IV) tramadol as analgesia for extremities injuries with moderate pain. Both groups received a single dose of 50 mg tramadol and reassessed at 15, 30, 45, 60 minutes. : A total of 232 patients were studied, and divided into group A (IV tramadol) and group B (S/C) (Table 1). There was higher incidence of adverse events in the IV group at 0, 15 and 30 minutes of administration and higher mean pain score associated with administration in the IV group. These adverse effects include nausea, vomiting, giddiness, dizziness, and allergic reactions. The total number of patients developing adverse effects was 34 of 112 patients in the intravenous group as compared to 14 of 120 patients in the subcutaneous group (Figure 1). S/C tramadol has less adverse effects and causes less pain as compared to IV tramadol in managing moderate pain with extremities injuries and could be considered for pain relief in mass casualty incidents.


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  1. Cardozo A, Silva C, Dominguez L, Botero B, Zambrano P, Bareno J. A single subcutaneous dose of tramadol for mild to moderate musculoskeletal trauma in the emergency department. World J Emerg Med. 2014;5(4), 275–278. doi: 10.5847/wjem.j.issn.1920-8642.2014.04.006 .
  2. Cordell WH, Keene KK, Giles BK, Jones JB, Jones JH, Brizendine EJ. The high prevalence of pain in emergency medical care. Am J Emerg Med. 2002; 20:165–169 .
  3. Schug SA. The role of tramadol in current treatment strategies for musculoskeletal pain. Ther Clin Risk Manag. 2007;3(5), 717–723 .

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  • Article Type: Conference Abstract
Keyword(s): adverse eventsanalgesiaintravenous and subcutaneous
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