Tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta‐analysis

Abstract

Background Arthroscopic knee surgery is a common technique used in Australia. Post‐operative pain is common and can lead to delayed discharge and impair early mobilization. Use of local anaesthesia can reduce pain while avoiding systemic side effects. This systematic review and meta‐analysis aimed to establish the use of tramadol as an adjunct to intra‐articular local anaesthetic infiltration in knee arthroscopy in the current literature. Methods Two independent reviewers performed a systematic search of four databases, where 24 articles were identified with six studies (four high‐quality and two low‐quality randomized controlled trials), with a total of 334 patients were included for analysis. RevMan 5.3 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used to perform the data analysis. The studies included focused on outcomes such as pain scores, breakthrough analgesia, total analgesia, time to discharge and adverse events related to the use of tramadol as an adjunctive therapy. Results This study found that using tramadol as an adjunct to intra‐articular local anaesthetic infiltration in arthroscopic knee surgery reduced post‐operative pain and increased time to breakthrough analgesia without an increase in side effects. Conclusion This meta‐analysis suggests that tramadol is an efficacious adjunct for use in intra‐articular local anaesthetic infiltration following arthroscopic knee surgery.

Do intra‐articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta‐analysis

“…Zeng et al 36 in a meta‐analysis have shown that a single intra‐articular injection of morphine after knee arthroscopy provides better pain relief and reduces the need for supplementary analgesics in the immediate post‐operative period. Similarly, meta‐analytic studies for intra‐articular fentanyl and tramadol have reported better pain relief after knee arthroscopy 8,9 . An RCT has also demonstrated significantly reduced pain scores up to 24 hours with intra‐articular buprenorphine after knee arthroscopy 37 .…”

“…20,35 Zeng et al 36 tramadol have reported better pain relief after knee arthroscopy. 8,9 An RCT has also demonstrated significantly reduced pain scores up to 24 hours with intra-articular buprenorphine after knee arthroscopy. 37 It is important to note that the use of intra-articular opioids in knee procedures have focused on pain relief only in the immediate post-operative period (up to 24 hours after surgery), unlike trials on TMJ arthrocentesis where the focus was on improving outcomes at short-term follow-up.…”

“…Several clinical trials have attempted to improve the efficacy of TMJ arthrocentesis by injecting corticosteroids, sodium hyaluronate, platelet‐rich plasma, etc into the joint space 5‐7 . Experience from arthroscopy procedures on knee joints has demonstrated that intra‐articular analgesics may be injected at the end of the procedure to provide early pain relief 8,9 . Inspired by these trials, several clinicians have also experimented with the use of intra‐articular analgesics after TMJ arthrocentesis 10,11 .…”

“…[5][6][7] Experience from arthroscopy procedures on knee joints has demonstrated that intra-articular analgesics may be injected at the end of the procedure to provide early pain relief. 8,9 Inspired by these trials, several clinicians have also experimented with the use of intra-articular analgesics after TMJ arthrocentesis. 10,11 In 2018, Gopalakrishnan et al 5 conducted a systematic review to analyse the evidence on the efficacy of such intra-articular drugs after TMJ arthrocentesis.…”

Peri- and Postoperative Pain Management in Multiple Ligament Knee Surgery in the Hospital and Ambulatory Surgery Center Setting

“…50 Tramadol is efficacious as an adjunct medication for postoperative pain management in arthroscopic knee surgery, although usage has not been studied specifically for multiligament knee injury. 51 Many of the discussed agents can be used in isolation or in combination as part of a balanced anesthetic. Furthermore, many studies have explored the additive benefits of these medications in combination with regional anesthesia for improved outcomes after surgery.…”