Tramadol Use Following TJA Surgery
Tramadol administered within 24 hours after surgery may reduce postoperative pain and opioid consumption after TJA within 72 hours after surgery, but may be associated with adverse events such as dizziness and dry mouth.
Anesthesia and Analgesia in Total Joint Arthroplasty (2020)
Developed by: American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, The Hip Society, and The Knee Society


Three studies evaluated the effects of tramadol on postoperative pain, opioid consumption, and complications after primary TJA. One high quality study compared the use of tramadol versus a placebo for treatment of pain after TJA.[34] Another high quality study compared tramadol to placebo and to paracetamol with codeine.[35] One additional high quality study compared tramadol to other opioid medications for treatment of pain after TJA. There were mixed results among all studies on the effects of tramadol on pain, patient-reported outcome scores, opioid consumption and adverse events after TJA.

            Both studies that compared tramadol to a non-opioid control found that there was no difference in pain relief between the control and tramadol.[34,35] However, each study found different results with regards to opioid consumption. Stiller et al. found that intravenous tramadol 100 mg/mL administered every 6 hours for 24 hours after surgery led to 31% lower morphine consumption in TKA patients measured via a morphine patient controlled analgesia (PCA) device.[34] Stubhaug et al. found that after THA the addition of either 50 mg or 100 mg oral tramadol did not result in any change in opioid consumption when compared to placebo.[35] When compared to paracetamol with codeine, both 50 mg and 100 mg oral tramadol resulted in less efficacious pain relief and opioid consumption. Pang et al. found that tramadol reduced opioids administered via a patient controlled analgesic device compared to placebo.[36]

            Adverse events including dizziness, dry mouth, and nausea were more common among patients who received tramadol compared to placebo.  A direct meta-analysis of two studies found that rates of dry mouth (1.97 relative risk; 95% confidence interval 1.04 to 3.75) and dizziness (1.50 relative risk; 95% confidence interval 1.12 to 2.00) were more common among patients who took tramadol compared to placebo.[35,36]

            Given the conflicting evidence with regards to opioid consumption, the fact that two studies evaluated intravenous tramadol which is not approved by the Food and Drug Administration in the United States, and that there was inconclusive evidence comparing the efficacy of tramadol to other opioids the strength of the recommendation was downgraded to moderate.


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The OrthoGuidelines Process