Intraperitoneal Tramadol in Abdominal Surgery: A Systematic Review.


Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand. Electronic address: [Email]


BACKGROUND : Multimodal analgesic regimes are required to treat pain. Intraperitoneal (IP) agents, such as local anesthetics (LAs), have been shown to reduce pain after abdominal surgery. Other IP analgesics have been tested in several randomized control trials (RCTs), but no reviews or guidelines have evaluated their use. Tramadol is an effective oral and intravenous analgesia with recent evidence supporting the use of IP tramadol (IPT). We aimed to review the efficacy of IPT as an adjunct to intraperitoneal local anesthetics (IPLAs) for pain relief after abdominal surgery.
METHODS : Relevant articles were identified by two independent reviewers from MEDLINE, EMBASE and PubMed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines up to January 2019. Only RCT comparing IPT + IPLA with IPLA alone were included. Outcomes recorded were the postoperative analgesic requirement, pain scores at 4 h and 24 h and adverse events. Data were analyzed with Review Manager, version 5.3.
RESULTS : A total of five RCTs (4× laparoscopic cholecystectomy and 1× abdominal hysterectomy) were included in this review from 419 studies screened. All doses were given as a single bolus. Pain relief requirements over the first 24 h weres less in the IPT + IPLA groups when compared with those in IPLA alone. Pain scores were less for IPT + IPLA groups at 4 h and 24 h. There were no significant differences in adverse events between groups.
CONCLUSIONS : In summary, IPT, in combination with IPLA, is effective in the management of acute postoperative pain and reduces the total amount of pain relief consumed in the first 24 h after surgery. Studies reporting the use of IPT + IPLA reported no toxicity or systemic adverse events. Further research into standardizing the dosing of IPT to optimize its effectiveness and further reduce the additional analgesic requirement is indicated.


Abdominal surgery,Intraperitoneal local anaesthetic,Intraperitoneal tramadol,Postoperative pain,

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