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Tramadol relieves pain during outpatient hysteroscopy

14 Mar 2019

Tramadol safely and effectively reduces pain during diagnostic outpatient hysteroscopy (OH), according to the results of a meta-analysis.

Researchers searched multiple online databases for studies examining the effect of tramadol vs placebo or any other active drug on pain, assessed using visual analogue scale (VAS), immediately and 30 minutes after OH. They evaluated bias risk according to the Cochrane tool.

The meta-analysis included four randomized clinical trials involving 488 patients who underwent OH, among whom 209 took tramadol, 70 celecoxib and 209 placebo for pain.

Pooled data showed that tramadol use led to a significant decrease in VAS scores during OH compared with placebo (weighted mean difference [WMD], −1.33; 95 percent CI, −1.78 to −0.88), without significant heterogeneity among the studies (I2, 3 percent; p=0.36).

Likewise, tramadol substantially reduced VAS scores immediately after the procedure (WMD, −1.05; −1.49 to −0.61) and 30 minutes after (WMD, −0.98; −1.30 to −0.65). There was no significant heterogeneity observed (I2, 0 percent; p=0.84 and I2, 0 percent; p=0.88, respectively).

In terms of safety, the incidence of adverse events including nausea, vomiting and bradycardia did not differ between tramadol and placebo.

Additional high-quality, large-scale studies are warranted to establish the best dose and route of administration needed to relieve pain during OH, as well as determine which patients are more likely to benefit from tramadol, researchers said.

Although OH is gaining popularity, the lack of appropriate analgesia proves to be an important limitation, researchers noted. Currently, there is no consensus on the best pain management protocol. Previous reports indicate that intramuscular tramadol is superior to an intracervical injection of mepivacaine, while oral tramadol is as good as oral celecoxib, but the lack of adverse events might favour celecoxib. [Hum Reprod 2016;31:60–66]

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