Advances in perioperative pain management: use of medications with dual analgesic mechanisms, tramadol & tapentadol

Anesthesiol Clin. 2010 Dec;28(4):647-66. doi: 10.1016/j.anclin.2010.08.009.


Recovery from ambulatory surgical procedures can be limited by postoperative pain. Inadequate analgesia may delay or prevent patient discharge and can result in readmission. More frequently, postoperative pain produces discomfort and interrupts sleep, contributing to postoperative fatigue. The development of effective analgesic regimens for the management of postoperative pain is a priority especially in patients with impaired cardiorespiratory, hepatic, or renal function. Tramadol and tapentadol hydrochloride are novel in that their analgesic actions occur at multiple sites. Both agents are reported to be mu-opioid receptor agonists and monoamine-reuptake inhibitors. In contrast to pure opioid agonists, both drugs are believed to have lower risks of respiratory depression, tolerance, and dependence. The Food and Drug Administration has approved both drugs for the treatment of moderate-to-severe acute pain in adults. This article provides an evidence-based account of the role of tramadol and tapentadol in modern clinical practice.

Publication types

  • Review

MeSH terms

  • Analgesics / therapeutic use*
  • Animals
  • Cytochrome P-450 CYP2D6 / physiology
  • Humans
  • Injections, Spinal
  • Pain, Postoperative / drug therapy*
  • Perioperative Care
  • Phenols / pharmacology
  • Phenols / therapeutic use*
  • Receptors, Opioid, mu / agonists*
  • Serotonin Syndrome / chemically induced
  • Tapentadol
  • Tramadol / adverse effects
  • Tramadol / pharmacology
  • Tramadol / therapeutic use*


  • Analgesics
  • Phenols
  • Receptors, Opioid, mu
  • Tramadol
  • Cytochrome P-450 CYP2D6
  • Tapentadol