A comparison of the effects of midazolam/fentanyl and midazolam/tramadol for conscious intravenous sedation during third molar extraction

J Oral Maxillofac Surg. 2011 Jun;69(6):1594-9. doi: 10.1016/j.joms.2010.09.005. Epub 2011 Feb 1.


Purpose: This study evaluated the effects of fentanyl and tramadol, used in combination, as sedation for third molar surgical extraction.

Patients and methods: This prospective, randomized, double-blind, placebo-controlled study included 60 patients undergoing extraction of a horizontal third molar with an Amsterdam Preoperative Anxiety and Information Scale score above 10 points. All of the patients were first given a 0.03-mg/kg bolus of midazolam, and then they were randomized into 3 groups: group A, midazolam only; group B, midazolam and 1-μg/kg fentanyl; and group C, midazolam and 1-mg/kg tramadol. The vital signs were recorded. Patients were assessed for postoperative pain and adverse effects, and patient and surgeon satisfaction was assessed.

Results: No differences were found in the heart rate among groups (P > .05). The mean blood pressure was also similar until the 40th minute, after which the mean blood pressure in the patients in group A was lower than that in the other 2 groups (P < .01). In the postoperative pain assessment, the visual analog scale scores of the patients in group C were lower than those in the other 2 groups in the first postoperative hour (P < .05). The time at which the first rescue analgesic was taken in groups A, B, and C was 3, 3.5, and 5 hours postoperatively, respectively, and was significantly later in group C (P < .01). No difference was found in patient/surgeon satisfaction among the groups.

Conclusions: Tramadol has a better analgesic effect in third molar surgery than fentanyl and placebo.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Anesthesia, Dental*
  • Anesthetics, Combined
  • Conscious Sedation*
  • Double-Blind Method
  • Fentanyl / administration & dosage*
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Midazolam / administration & dosage*
  • Molar, Third / surgery*
  • Pain Measurement
  • Pain, Postoperative
  • Patient Satisfaction
  • Tooth Extraction*
  • Tooth, Impacted / surgery
  • Tramadol / administration & dosage*


  • Analgesics, Opioid
  • Anesthetics, Combined
  • Hypnotics and Sedatives
  • Tramadol
  • Midazolam
  • Fentanyl