Patients with pain contribute to 60-70% of Emergency Department attendance. Tramadol is analgesic of choice despite its weak opiod agonist properties.We conducted a prospective study to examine the effectiveness of intravenous Tramadol among severe traumatic pain patients. In the study, eligible patients received loading dose of intravenous Tramadol 2mg/kg. Intermittent intravenous Tramadol 20mg was administered every 10 minutes after the loading dose if visual analogue score (VAS) more than 30 mm. At 30 minutes study, those patients with persistent pain or VAS more than 30 mm received rescue medication.VAS score, vital signs and side effects were recorded for every 10 minutes. Forty- seven patients with fracture and soft tissue injury were involved in the study. The median dose of IV Tramadol received at the end of the study was 150 +/- 34.0 mg. There was a significant change in medium pain score at 10, 20 and 30 minutes treatment (p<0.001). About 66.1% of studied patients had tramadol side effects within the 30 minutes. We conclude that the intravenous Tramadol use should be encouraged in traumatic patients.

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Assoc. Prof. Dr. Rashidi Ahmad and Dr. Chew Keng Sheng are lecturer and Consultant Emergency Physician at School of Medical Sciences, Universiti Sains Malaysia, Malaysia. Dr. Lim Chee Kean is a Clinical Specialist of Emergency Medicine who has a strong interest in resuscitation.