Tramadol as a patient‐initiated component of multimodal pain management: a pilot study of 364 lower limb arthroplasty cases

Abstract

BackgroundMultimodal therapy (MMT) for analgesia following joint arthroplasty continues to reduce cost and the requirement of strong opioids post‐operatively. Tramadol immediate release is an important MMT component providing synergistic pain relief via dual μ‐opioid agonism and serotonin and noradrenaline reuptake inhibition. Case reports have shown tramadol when combined with antidepressants cause serotonin syndrome, but this has yet to be demonstrated in larger studies. We undertook a pilot study assessing the functional outcomes and incidence of side effects associated with tramadol in lower limb arthroplasty patients with a focus on those taking concomitant antidepressants.MethodsPrimary and revision hip and knee arthroplasties performed in 2018–2019 by a senior surgeon were included (n = 364). Patient records were assessed to determine pain scores, length of hospitalization, prescription of tramadol and antidepressants, self‐reported side effects and previous adverse reactions associated with tramadol.ResultsNine‐five percentage of patients had been prescribed tramadol, and 16% had concurrent prescription of tramadol and one or more antidepressants. The total rate of adverse effects associated with tramadol before and during the study was 7% (n = 25) including two cases of concomitant tramadol and antidepressant use. For patients on tramadol, median 2‐week post‐operative pain score was 1.5 (IQR 1–2.5) out of 10 and hospitalization length was 1 (IQR 1–2) days.ConclusionTramadol immediate release appears to be well tolerated among our patient population with no significantly increased prevalence of side effects when co‐administered with low and moderate dose antidepressants.