Open Access Open Access  Restricted Access Subscription or Fee Access

Effects of perineural tramadol on sensory and motor conduction of ulnar nerve

Ertan Öztürk, MD, Murat Zinnuroğlu, MD, Özer Ali Sezer, MD, İsmail Gökyar, MD, Mehmet Beyazova, MD, Kadir Kaya, MD


Study objective: We aimed to study the effects of perineural tramadol on both sensory and motor conduction of ulnar nerve by electroneurography (ENG).
Design: Prospective.
Setting: Physical Medicine and Rehabilitation Electrophysiology Laboratory.
Patients: Eight healthy volunteers.
Intervention: Either 3-mL of saline or 50 mg of tramadol in 3-mL saline was initially administered perineurally to ulnar nerve of nondominant extremity. After two weeks, volunteers who received tramadol were given saline, whereas the ones who received saline were given tramadol.
Measurements: Baseline sensory and motor responses of ulnar nerve were recorded by ENG prior to injection of study solutions. Perineural injections were realized by means of a teflon-coated needle and a nerve stimulator. Following injections, sensory and motor responses were monitored every five minutes in the first hour and then every 10 minutes until the sensory and motor amplitudes reached at least 80 percent of the baseline value.
Main Results: Perineural tramadol administration showed a significant decrease from baseline measurement in the sensory response amplitude with respect to saline administration (65.9 percent vs 12.7 percent, p < 0.05). Decrease in the motor response amplitudes from baseline versus saline was insignificant (32.9 percent vs 15.2 percent). Sensory block was observed in all of the subjects after tramadol injection when compared with saline administration and lasted 25 minutes (p < 0.05). The duration of motor block lasted 12.5 minutes, and motor block developed in four out of eight subjects when compared with saline administration (p < 0.05). Time to reach maximum sensory and motor block were 15 and 10 minutes, respectively, after tramadol injection.
Conclusions: Tramadol has a brief local anesthetic-like action when administered to ulnar nerve perineurally.


tramadol, perineural, nerve block, nerve conduction, electroneurography

Full Text:



Shipton EA: Tramadol: Present and future. Anaesth Intensive Care. 2000; 28: 363-374.

Pang WW, Mok MS, Chang DP, et al.: Local anesthetic effect of tramadol, metoclopramide, and lidocaine following intradermal injection. Reg Anesth Pain Med. 1998; 23: 580-583.

Altunkaya H, Ozer Y, Kargi E, et al.: Comparison of local anesthetic effects of tramadol with prilocaine for minor surgical procedures. Br J Anaesth. 2003; 90: 320-322.

Kapral S, Gollmann G, Waltl B, et al.: Tramadol added to mepivacaine prolongs the duration of an axillary brachial plexus blockade. Anesth Analg. 1999; 88: 853-856.

Robaux S, Blunt C, Viel E, et al.: Tramadol added to 1.5 percent mepivacaine for axillary brachial plexus block improves postoperative analgesia dose-dependently. Anesth Analg 2004; 98: 1172-1177.

Mert T, Güneş Y, Güven M, et al.: Comparison of nerve conduction blocks by an opoid and local anesthetic. Eur J Pharmacol. 2002; 439: 77-81.

Grant GJ, Vermeulen K, Zakovski MI, et al.: Perineural antinociceptive effect of opioids in a rat model. Acta Anaesthesiol Scand. 2001; 45: 906-910.

Beyazova M, Öztürk E, Zinnuroğlu M, et al.: Effect of perineurally administered tramadol on nerve conduction. EFIC–Pain in Europe IV, Prague-Czech Republic, September 2-6, 2003. Book of Abstracts; 284 T.

Dimutru D, Amato AA, Machiel JZ: Nerve conduction studies. In Dumitru D, Amato AA, Machiel JZ (eds.): Electrodiagnostic Medicine, 2nd ed. Philadelphia: Hanley & Belfus Inc, 2002; 159-223.

Stein C: Peripheral mechanisms of opioid analgesia. Anesth Analg. 1993; 76: 182-191.

Murphy DB, McCartney CJ, Chan VW: Novel analgesic adjuncts for brachial plexus block: A systematic review. Anesth Analg. 2000; 90: 1122-1128.

Kaya K, Babacan A, Beyazova M, et al.: Effects of perineural opioids on nerve conduction of n. suralis in man. Acta Neurol Scand. 1992; 85: 337-339.

Beyazova M, Babacan A, Bilir E, et al.: Perineural pethidine: effects of different doses on nerve conduction. Eur J Anaesthesiol. 1993; 10: 353-356.

Flanagan MT, Walker FO, Butterworth J: Failure of meperidine to anesthetize human median nerve: A blinded comparison with lidocaine and saline. Reg Anesth. 1997; 22:73-79.

Oztürk E, Beyazova M, Kaya K, et al.: Effect of meperidinelidocaine combination on nerve conduction. EFIC, Pain in Europe IV, Prague-Czech Republic, September 2-6, 2003, Book of Abstracts; 285F.

Mannion S, O’Callaghan S, Murphy DB, et al.: Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5 percent: A randomized double-blinded study. Br J Anaesth. 2005; 94: 352-356.

Acalovschi I, Cristea T, Margarit S, et al.: Tramadol added to lidocaine for intravenous regional anesthesia. Anesth Analg. 2001; 92: 209-214.

Alhashemi JA, Kaki AM: Effect of intrathecal tramadol administration on postoperative pain after transurethral resection of prostate. Br J Anaesth. 2003; 91: 536-540.

Grace D, Fee JP: Ineffective analgesia after extradural tramadol hydrochloride in patients undergoing total knee replacement. Anaesthesia. 1995; 50: 555-558.

Baraka A, Jabbour S, Ghabash M, et al.: A comparison of epidural tramadol and epidural morphine for postoperative analgesia. Can J Anaesth. 1993; 40: 308-313.

Siddik-Sayyid S, Abuad-Maroun M, Sleiman D, et al.: Epidural tramadol for postoperative pain after cesarean section. Can J Anaesth. 1999; 46: 731-735.

Tsai YC, Chang PJ, Jou IM: Direct tramadol application on sciatic nerve inhibits spinal somatosensory evoked potentials in rats. Anesth Analg. 2001; 92: 1547-1551.

Nolte H, Fruhstorfer H, Edström HH: Local anesthetic efficacy of ropivacaine (LEA 103) in ulnar nerve block. Reg Anesth. 1990; 15: 118-124.

Raffa RB, Friderichs E, Reimann W, et al.: Opioid and nonopioid components independently contribute to the mechanisms of action of tramadol, an atypical opioid analgesic. J Pharmacol Exp Ther. 1992; 260: 275-285.

Tarkkila P, Touminen M, Lingren L: Comparison of respiratory effects of tramadol and pethidine. Eur J Anaesthesiol. 1998; 15: 64-68.

Bamigbade TA, Davidson C, Langford RM, et al.: Actions of tramadol, its enantiomers and principal metabolite, O-desmethyltramadol, on seretonin (5-HT) afflux and uptake in the rat dorsal raphe nucleus. Br J Anaesth. 1997; 79: 352-356.

Guven M, Mert T, Gunay I: Effects of tramadol on nerve action potentials in rat: Comparisons with benzocaine and lidocaine. Int J Neurosci. 2005; 115: 339-349.

Marincsák R, Tóth BI, Czifra G, et al.: The analgesic drug, tramadol, acts as an agonist of the transient receptor potential vanilloid-1. Anesth Analg. 2008; 106: 1890-1896.

Hassan HG, Youssef H, Renck H: Duration of experimental nerve block by combinations of local anesthetic agents. Acta Anaesthesiol Scand. 1993; 37: 70-74.



  • There are currently no refbacks.