Intraperitoneal Tramadol in Abdominal Surgery: A Systematic Review

Area of Science:

• Anesthesiology
• Pharmacology
• Surgical Pain Management

Background:

• Multimodal analgesia is crucial for effective pain management.
• Intraperitoneal (IP) agents, including local anesthetics (LAs), are used for post-abdominal surgery pain.
• Evidence supports IP tramadol (IPT) as an adjunct to IP local anesthetics (IPLAs).

Purpose of the Study:

• To review the efficacy of IP tramadol (IPT) as an adjunct to IP local anesthetics (IPLAs).
• To evaluate pain relief after abdominal surgery using IPT + IPLA compared to IPLA alone.

Main Methods:

• Systematic review of randomized control trials (RCTs) identified via MEDLINE, EMBASE, and PubMed up to January 2019.
• Included RCTs compared IPT + IPLA versus IPLA alone for abdominal surgery.
• Outcomes assessed: postoperative analgesic requirement, pain scores at 4h and 24h, and adverse events.

Main Results:

• Five RCTs (4 laparoscopic cholecystectomy, 1 abdominal hysterectomy) were included.
• IPT + IPLA groups showed reduced 24-hour analgesic requirements compared to IPLA alone.
• Pain scores were significantly lower at 4h and 24h in the IPT + IPLA groups.
• No significant differences in adverse events were observed between the groups.

Conclusions:

• IP tramadol (IPT) combined with IP local anesthetics (IPLAs) effectively manages acute postoperative pain.
• This combination reduces the need for additional analgesics within the first 24 hours post-surgery.
• No toxicity or systemic adverse events were reported, but further research on optimal dosing is recommended.