The purpose of this study was to assess the efficacy of local anesthetic and tramadol combinations in the prevention of pain after the surgical extraction of third molars.

The surgical removal of impacted third molar teeth is a procedure that is frequently encountered in oral and maxillofacial surgery practices. Pain following these operations is one of the most important factors affecting patient satisfaction. Several pain-management strategies are available. An alternative approach to pain control is to maximize drug levels at the tissue injury site by administering drugs locally.

Tramadol is a centrally acting opioid that provides good analgesia. It reduces the transmission of pain impulses by inhibiting serotonin and norepinephrine re-uptake. In addition to the systemic analgesic effects, the local anesthetic effects of tramadol on the peripheral nerves have been presented in multiple clinical and laboratory studies.

The aim of this study is to test the clinical efficacy of local anesthetic and tramadol combinations during and after the surgical extraction of the lower third molars.

Inclusion Criteria:

• Score of ASA I-II (American Society of Anesthesiologists Physical Status I or II)
• Patient weights were less than 60 kg

Exclusion Criteria:

• Subjects who had taken a sedative, tranquillizer, or analgesic medication within the last 24 h,
• Sensitive to tramadol,
• Patients who needed an extra dose of anesthetic solution during the surgery

The solutions were prepared prior to the procedure by an anesthetic nurse who was not involved in the study. Investigator was blind to the groups.