Efficacy and safety of tramadol in pain relief during diagnostic outpatient hysteroscopy: systematic review and meta-analysis of randomized controlled trials

To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH). Systematic review and meta-analysis of randomized controlled trials. Not applicable. Patients undergoing diagnostic OH received tramadol versus those who were administered placebo. Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic). Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure. 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, I2 = 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = −1.05; 95% CI −1.49 to −0.61, I2= 0, P = .84) and 30 minutes after (WMD = −0.98; 95% CI −1.30 to −0.65, I2 = 0, P = .88). This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH. Eficacia y seguridad del tramadol en el alivio del dolor durante la histeroscopia diagnóstica ambulatoria: revisión sistemática y metaanálisis de ensayos controlados aleatorizados Evaluar la evidencia sobre la seguridad y la eficacia de tramadol en el alivio del dolor durante la histeroscopia diagnóstica ambulatoria (HSC). Revisión sistemática y metaanálisis de ensayos controlados aleatorizados. No aplicable. Pacientes sometidos a una HSC diagnóstica que recibieron tramadol frente a los que recibieron placebo. Se realizaron búsquedas en las bases de datos electrónicas utilizando los siguientes términos de MeSH (tramadol O opioides O opioides O narcóticos) E (histeroscopia O histeroscópico). El dolor evaluado por la escala analógica visual (VAS) durante la HSC, inmediatamente y 30 minutos después del procedimiento. Se identificaron ciento trece estudios, de los cuales cuatro ensayos clínicos aleatorizados se consideraron elegibles para esta revisión (tramadol: n = 209; placebo: n = 209). La estimación combinada mostró que el tramadol redujo significativamente el VAS durante el procedimiento comparado con el placebo (diferencia de medias ponderada [DMP] = -1.33; intervalo de confianza del 95% [IC] 1.78 a -