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 = 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = -1.05; 95% CI -1.49 to -0.61, I= 0, P = .84) and 30 minutes after (WMD = -0.98; 95% CI -1.30 to -0.65, I = 0, P = .88).

Conclusion(s): This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH.