الفهرس 
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Abstract
Analgesia is one of the hallmarks of anaesthetic practice since peri operative pain is a potent trigger of stress response and adverse effects on various organ systems (Kehlet, 199/). Opioids and non steroidal anti-inflammatory drugs have been the corner-stone of pain tnanagement. During the last two decades great information on pain mechanisrns has lead to evolution of new analgesic drugs. Tranladol is a centrally acting analgesic. It has a dual mechanism of action: a weak opioid-~-agonist and a monoaminergic spinal inhibition action (Kayser et al., 1992). The two modes of action are synergistic allowing use of tramadol in prevention and managetnent of nociceptive pain (Mostch et al., 1990). Clinical profile of tramadol proved to show less depressant respiratory action than morphine (Hounles et al., 1992). The drug was found to be effective orally, intramuscular, intravenous and in epidural analgesia (Delikane & Vijyan, 1993).