[On-demand analgesia with tramadol in bilateral multiple rib fractures]

A 41-year-old woman sustained bilaterally multiple rib fractures in a severe car accident. She developed severe pain-related dyspnoea. On-demand analgesia with tramadol (by pressing a button the patient could self-administer single doses of 20 mg) rapidly decreased the pain and respiration became almost normal. Daily doses of about 400 mg were sufficient. The ability to self-administer the analgesic clearly was an important psychological factor in the good response to the usually relatively weakly effective opioid.