Tehran University Medical Journal

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Introduction: The objective of the present study is to compare the respiratory function and pain relief of two parenteral analgesics tramadol and morphine under clinical conditions.

Materials and Methods: The trial was conducted as an open label-randomized, single center study. The study was performed during 3 months in 1999. In total, 64 patients were enrolled in Shariatie University Hospital, while the other 32 patients were treated with morphine.

Results: There were 12 male and 20 female in either groups. The mean age was 48±15 in tramadol versus 43±16 morphine group. Concerning the amount of the medication given to the patients. It would be observed that tramadol patients received 194±72 mg and morphine patients 17±7 mg out of drugs. At study admission vital signs were recorded. The pulse rate, blood pressure and respiratory rate are presented revealing no obvious differences between the treatment groups. There was a broad range regarding the underlying type of operation, however, a laparatomy or a cholecystectomy was performed in 24 (75.0%) Vs. 26 (81.3%) patients, respectively. All 64 patients were receiving anaesthetics as stipulated in the protocol. Of them being diazepam, sufentanil, succinylcholine chloride and thiopental as the most frequent reported, 4 Vs. 3 patient were given additional fentanylin a mean dosage of 220 mg Vs. 83 mcg. The oxygen saturation was the main safety parameter of the present study. No obvious differences between the two treatment groups can be detected (P<0.472). Primary efficacy end point was the pain assessment. The pain intensity at each scheduled time point was recorded. At study inclusion no differences between the treatment groups uncured, but during the 24 hour observation period the tramadol patients were in advantage (P<0.001).

Conclusion: This study shows that long-term efficacy of tramadol is better than morphine.

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Background: Acute lung injury (ALI) is a pulmonary pathology occuring in context of infection, trauma, burn, and sepsis. Tissue injury and release of chemical mediators result in tissue damage and organ failure especially respiratory failure. Many therapeutic modalities including vitamin E, allopurinol, and N-acetylcystein (NAC) have been used to decrease levels of inflammatory factors and to control and improve signs and symptoms. The antioxidant feature of NAC induces synthesis of glutathione- the scavenger of free radicals- and increase respiratory drive and PaO₂. In time diagnosis of ALI, prompt institution of treatment will reduce mortality and morbidity in critical illness.
Methods: This open label analytical clinical trial included a total of 50 patients admitted in the ICU ward of Sina University Hospital. They were randomly divided into two groups of 25, the case group received NAC 150mg/kg in 100ml Normal saline within 20 minutes then 50mg/kg in 100ml Normal saline within 4 hr after that 50mg/kg daily for three days. The controls received only normal saline. Oxygenation and ventilation parameters were studied In both groups.
Results: There were no significant difference between the groups in terms of demographic indices, mean SpO₂, ABG values, mortality rates, and clearing of chest x-rays. The best outcome was seen in young traumatic patients.

Conclusion: In this relatively small group of patients presenting with an established ALI/ ARDS subsequent to a variety of underlying disease, intravenous NAC treatment during first four days neither significantly improved systemic oxygenation nor reduced the need for ventilatory support.