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.
Both studies that compared tramadol to a non-opioid control found that there was no difference in pain relief between the control and tramadol.
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.
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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- Pang W-W, Mok MS, Lin C-H, Yang T-F, Huang M-H. Comparison of patient-controlled analgesia (PCA) with tramadol or morphine. Can J Anesthesia 1999;46:1030–5. doi:10.1007/bf03013197