Local infiltration of tramadol as an effective strategy to reduce post-operative pain: a systematic review protocol and meta-analysis

Maria Beatrice Passavanti,Caterina Aurilio,Marco Fiore,Giacomo Piccinno,Vincenzo Pota,Maria Caterina Pace,Sveva Di Franco,Pasquale Sansone,Giuseppe Mangoni,Aniello Alfieri

doi:10.1186/s13643-020-01419-1

Abstract

ObjectiveThe purpose of this review is to evaluate the use and effectiveness of the local administration of tramadol in reducing post-operative pain during surgical interventions.MethodsThe PubMed, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases will be searched for this review. This systematic review will include studies evaluating the clinical efficacy of the local infiltration of tramadol, with no study design restrictions. Only studies that present clear descriptions of local tramadol administration are published in peer-reviewed journals in the English, Italian, Spanish, French, Portuguese or German language and are published in full will be taken into consideration. A meta-analysis will be performed when there is sufficient clinical homogeneity among the retrieved studies, and only randomized controlled studies and quasi-randomized controlled studies will be included. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to assess the certainty in the evidence. If a quantitative analysis cannot be conducted, a qualitative description of the results of the retrieved studies will be provided.ResultsA high-quality synthesis of the current evidence on the local administration of tramadol for managing post-surgical pain will be illustrated using subjective reports and objective measures of performance. The primary outcomes will include the magnitude of post-operative pain intensity improvement, with improvement being as defined by a reduction by at least 2 points in the visual analogue scale (VAS) score or numerical rating scale (NRS) score. The secondary outcomes will be the magnitude of reduction in tramadol rescue doses and in other analgesic drug doses.ConclusionThis protocol will present evidence on the efficacy of tramadol in relieving post-surgical pain.Systemic review registrationPROSPERO CRD42018087381

Highlights

Several surgical procedures are performed every day worldwide, and most of them are painful or uncomfortable for patients
Due to advances in knowledge and anaesthetic techniques, many diagnostic procedures and an increasing number of surgical procedures can be performed under local anaesthesia
Post-operative pain is defined by a non-zero score for the numerical rating scale (NRS), visual analogue scale (VAS) or other ageappropriate pain assessment tools at the end of the surgical procedure

Summary

Introduction

Several surgical procedures are performed every day worldwide, and most of them are painful or uncomfortable for patients. Local anaesthetics are generally safe, these agents can be toxic if administered inappropriately, and in some cases, they may lead to unintended reactions, even when they are properly administered. The rate of severe cases of toxicity (convulsive seizures with or without cardiac events) is approximately 1:10,000 for epidural analgesia and approximately 1:1000 for peripheral nerve blocks [6]. These toxic events result from the direct injection of such drugs into a vascular space or the absorption of these drugs by surrounding tissues. Systemic adverse events include hypertension and tachycardia, conduction defects and arrhythmias, tinnitus, tonic-clonic seizures, decreased level of consciousness, apnoea and cardiac arrest

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Results

Conclusion