Efficacy and safety of tramadol in pain relief during diagnostic outpatient hysteroscopy: systematic review and meta-analysis of randomized controlled trials

Objective: To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH). Design: Systematic review and meta-analysis of randomized controlled trials. Setting: Not applicable. Patient(s): Patients undergoing diagnostic OH received tramadol versus those who were administered placebo. Intervention(s): Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic). Main Outcome Measure(s): Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure. Result(s): One hundred thirteen studies were identified of which four randomized clinical trials were deemed eligible for this review (tramadol: n = 209; placebo: n = 209). The pooled estimate showed that tramadol significantly reduced VAS during procedure than placebo (weighted mean difference [WMD] = −1.33; 95% confidence interval [CI] −1.78 to −0.88, I 2 = 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = −1.05; 95% CI −1.49 to −0.61, I 2 = 0, P = .84) and 30 minutes after (WMD = −0.98; 95% CI −1.30 to −0.65, I 2 = 0, P = .88). Conclusion(s): This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH.