Can't Stop the Music? Musical Hallucinations From Postoperative Tramadol Use: Case Report and Literature Review

Tramadol is an overall safe and increasingly used alternative to traditional opioid medications for pain relief in the acute postoperative period. However, it does have a set of common and rarer, possibly life altering, side effects including severe hallucinations, and more specifically, discrete musical hallucinations. A 79-year-old female status post revision hip arthroplasty was started on Tramadol so that she could stop taking oxycodone. Within 3 days of the initiation of this medication, symptoms of severe musical hallucinations began. The symptoms continued for multiple weeks, were too difficult to assess causation, and resolved within 7 days of the cessation of tramadol use. This case describes a rare adverse effect of Tramadol, musical hallucinations, which led to the patient developing severe anxiety, sleep deprivation, postoperative dissatisfaction, and an increased risk of falls and injury due to fatigue and confusion. Based on this report, the authors recommend that surgeons ensure clinic staff who manage patient calls and messages are familiar with both common and uncommon medication side effects, and that they are trained to discontinue the medication if unusual symptoms arise until appropriate evaluation can be completed.