Analgesic Efficacy and Safety of Local Infiltration of Tramadol in Pediatric Tonsillectomy Pain: A Systematic Review and Meta‐Analysis

Abstract

Objectives The aim of this systematic review and meta‐analysis was to appraise clinical evidence of the impact of peritonsillar infiltration of tramadol, on postoperative pain control and the occurrence of adverse effects in children undergoing tonsillectomy. Methods A database search was conducted to identify randomized controlled trials (RCTs) pertinent to peritonsillar infiltration of tramadol compared to no treatment (placebo) or other analgesic regimens. The outcomes of interest were postoperative pain intensity, time to first analgesic demand, rescue analgesic consumption up to 24 hours after intervention, and the occurrence of adverse events. Results Twelve RCTs enrolling 972 pediatric patients were selected for qualitative analysis, among which eight were suitable for meta‐analysis. Tramadol infiltration induced a significant reduction of pain intensity up to 24 hours post‐tonsillectomy (mean difference [MD], −2.31; 95% confidence interval [CI], −3.49 to −1.12; P < 0.001; I2 = 97%) and time to first analgesic (MD 180.54; 95% CI, 56.91 to 304.18; P = 0.004; I2 = 99%), with no profound impact on postoperative nausea and vomiting (risk ratio [RR] 0.98; 95% CI, 0.73 to 1.32; P = 0.90; I2 = 0%) compared to the placebo group. The analgesic efficacy of tramadol infiltration was equivalent to the local or systematic use of ketamine or infiltration with local anesthetics. This effect was further enhanced when tramadol infiltration served as an adjunct to other analgesic interventions. No serious adverse events were reported. Conclusions In children undergoing tonsillectomy, peritonsillar infiltration of tramadol is associated with a postoperative analgesic benefit when compared to placebo, with negligible adverse events. Yet, no definite conclusion can be drawn due to the low quality, considerable heterogeneity, and paucity of the available data.

The analgesic Efficacy and Safety of Topically Applied Tramadol in Peritonsillar Space During Pediatric Adenotonsillectomy: A Meta-Analysis

“…[31][32][33][34] In the previous meta-analyses, the effect of peritonsillar applied tramadol on postoperative pain relief was investigated. 9,35,36 However, unlike in these studies, in our current study, peritonsillar applied topical tramadol was compared simultaneously with placebo or other drugs infiltrated to tonsil bed. In addition, subgroup analysis by time after pediatric adenotonsillectomy was done.…”

Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis

“…The adverse effects of tramadol have been evaluated in other systematic reviews and meta-analyses. Tsaousi et al, 2020 found a negligible association of adverse effects after local administration of tramadol in children undergoing tonsillectomy [ 53 ]. In this sense, Mattar et al, 2019, carried out the evaluation of analgesia and adverse effects of tramadol during a diagnostic outpatient’s hysteroscopy and reported that the pooled analysis showed no increase in the risk of minor adverse effects, such as nausea, vomiting, and bradycardia [ 54 ].…”

The effect of local tramadol infiltration in post pyelolithotomy pain.

“…20 Georgia Georgia GG Georgia G et al concluded that peritonsillar infiltration of tramadol resulted in significant reduction in post tonsillectomy pain intensity up to 24 hours. 21 Tugce Simsek et al compared the trans mucosal application in nasal packing infiltrated with tramadol, Lidocaine and saline. They suggested that patients in tramadol group were most satisfied and required least additional analgesics compared with Lidocaine and saline group.…”