Effects of Intravenous Lipid Emulsion on Tramadol-Induced Seizure; a Randomized Clinical Trial
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
,
Page e20
https://doi.org/10.22037/aaem.v9i1.1070
Abstract
Introduction: There are numerous studies on the efficacy of intralipid emulsion (ILE) in various xenobiotic toxicities. This study aimed to evaluate the potential role of ILE as an antidote in tramadol-induced seizure.
Methods: A single-blind clinical trial was undertaken to establish the efficacy and safety of ILE in patients with acute tramadol intoxication, who referred to Booali Hospital in Qazvin. Patients were randomly assigned to 2 groups. The Control group received standard care while the intervention group received intralipid emulsion (ILE) 20% in addition to the standard care. The occurrence of in-hospital seizure was compared between the groups.
Results: 80 patients who abused tramadol and met the study criteria were randomly assigned to either the intervention (40 cases) or the control (40 cases) group. Seizure occurred in 44 (56%) patients before admission to the emergency department. There were not any statistical differences between the groups regarding sex distribution (p=0.513) and mean age (p=0.19), presenting vital signs (p < 0.05), laboratory findings (p < 0.05), and mean abused dose of tramadol (p = 0.472) as well as occurrence of prehospital seizure (p = 0.7). In-hospital seizure occurred in 15 (18.75%) cases (all in the control group; p < 0.001). The mean duration of admission was 2.01 ± 1.13 days in the control group and 2.15 ± 1.04 days in the intervention group (p = 0.6). The number needed to treat for ILE to prevent tramadol-induced seizure was 2.7 (37.5% absolute risk reduction).
Conclusions: The findings of this study supported ILE administration, as an adjunct to standard antidote protocols, in tramadol intoxication to prevent tramadol-induced seizures.
- Tramadol
- soybean oil
- phospholipid emulsion
- Poisoning
- Seizure
- Clinical trial
How to Cite
References
King S, Forbes K, Hanks G, Ferro C, Chambers E. A systematic review of the use of opioid medication for those with moderate to severe cancer pain and renal impairment: a European Palliative Care Research Collaborative opioid guidelines project. Palliat Med. 2011;25(5):525-52.
Mori F, Barni S, Manfredi M, Sarti L, Pecorari L, Pucci N, et al. Anaphylaxis to Intravenous Tramadol in a Child. Pharmacology. 2015;96(5-6):256-8.
Bassiony MM, Salah El-Deen GM, Yousef U, Raya Y, Abdel-Ghani MM, El-Gohari H, et al. Adolescent tramadol use and abuse in Egypt. Am J Drug Alcohol Abuse 2015;41(3):206-11.
Vahabzadeh M, Moshiri M, Mohammadpour AH, Hosseinzadeh H. Promising effects of intravenous lipid emulsion as an antidote in acute tramadol poisoning. Reg Anesth Pain Med. 2013;38(5):425-30.
Shadnia S, Soltaninejad K, Heydari K, Sasanian G, Abdollahi MJH, toxicology e. Tramadol intoxication: a review of 114 cases. Hum Exp Toxicol. 2008;27(3):201-5.
Cao D, Heard K, Foran M, Koyfman A. Intravenous lipid emulsion in the emergency department: a systematic review of recent literature. J Emerg Med. 2015;48(3):387-97.
French D, Smollin C, Ruan W, Wong A, Drasner K, Wu AHJCt. Partition constant and volume of distribution as predictors of clinical efficacy of lipid rescue for toxicological emergencies. Clin Toxicol (Phila). 2011;49(9):801-9.
Vahabzadeh M, Moshiri M, Mohammadpour AH, Hosseinzadeh H. Promising effects of intravenous lipid emulsion as an antidote in acute tramadol poisoning. Regional Anesthesia & Pain Medicine. 2013;38(5):425-30.
Rosenblatt MA, Abel M, Fischer GW, Itzkovich CJ, Eisenkraft JBJATJotASoA. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006;105(1):217-8.
Ziaee M, Hajizadeh R, Khorrami A, Sepehrvand N, Momtaz S, Ghaffari S. Cardiovascular Complications of Chronic Opium Consumption: A Narrative Review Article. Iran J Public Health. 2019;48(12):2154-64.
Talaie H, Panahandeh R, Fayaznouri MR, Asadi Z, Abdollahi MJJomt. Dose-independent occurrence of seizure with tramadol. Toxicol Invest. 2009;5(2):63-7.
Ahmadimanesh M, Shadnia S, Rouini MR, Sheikholeslami B, Nasab SA, Ghazi-Khansari MJDm, et al. Correlation between plasma concentrations of tramadol and its metabolites and the incidence of seizure in tramadol-intoxicated patients. Drug Metab Pers Ther. 2018;33(2):75-83.
Talaie H, Panahandeh R, Fayaznouri MR, Asadi Z, Abdollahi MJJomt. Dose-independent occurrence of seizure with tramadol. 2009;5(2):63-7.
Jovanović-Čupić V, Martinović Ž, Nešić NJCt. Seizures associated with intoxication and abuse of tramadol. Clin Toxicol (Phila). 2006;44(2):143-6.
Marquardt KA, Alsop JA, Albertson TE. Tramadol exposures reported to statewide poison control system. Ann Pharmacother. 2005;39(6):1039-44.
Spiller HA, Gorman SE, Villalobos D, Benson BE, Ruskosky DR, Stancavage MM, et al. Prospective multicenter evaluation of tramadol exposure. J Toxicol Clin Toxicol. 1997;35(4):361-4.
Farzaneh E, Samadzadeh M, Shahbazzadegan B, Sayadrezai I, Mostafazadeh B, Sarbandi Farahani A, et al. Comparing the Frequency of Seizure in Patients Intoxicated with Tramadol Treated with or without Naloxone. J Res Med Sci. 2012;30(197).
Beyaz SG, Sonbahar T, Bayar F, Erdem AFJA, essays, researches. Seizures associated with low-dose tramadol for chronic pain treatment. Anesth Essays Res 2016;10(2):376.
Taghaddosinejad F, Mehrpour O, Afshari R, Seghatoleslami A, Abdollahi M, Dart RC. Factors related to seizure in tramadol poisoning and its blood concentration. J Med Toxicol. 2011;7(3):183.
Vahabzadeh M, Moshiri M, Mohammadpour AH, Hosseinzadeh H. Promising effects of intravenous lipid emulsion as an antidote in acute tramadol poisoning. Regional anesthesia and pain medicine. 2013;38(5):425-30.
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