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We searched for RCTs indexed in the following databases: CENTRAL, PUBMED, and EMBASE. We attempted to identify all relevant studies, regardless of language or publication status (published, unpublished). 20, 21 The protocol was registered with PROSPERO, under number CDR 42013006285, on November 13, 2013. This systematic review was performed in accordance with the criteria of the PRISMA statement and the current recommendations of the Cochrane Collaboration. We thus undertook a systematic review of RCTs comparing the efficacy and safety of tramadol vs placebo or active controls for the treatment of post-surgical pain. 17 It is currently unclear to what extent perioperative tramadol decreases postoperative opioid consumption, opioid-related side-effects, and pain intensity. 19 However, other authors reported that the monoaminergic modulation induced by tramadol made this drug valuable for combination with morphine.
#Datathief tolerance trial
The first randomized controlled trial (RCT) investigating the efficacy of tramadol in combination with potent opioids in 1995 reported negative results, 7 but several additional trials have since reported conflicting results, 8–18 including one study suggesting tramadol and morphine could be infra-additive. 6 However, the value of tramadol–morphine combinations remains uncertain. Tramadol, administered parenterally or orally, has proven to be an effective and well-tolerated analgesic for the management of moderate to severe acute postoperative pain in adults. 5 Tramadol is also a weak opioid, acting on μ-receptors. The non-opioid effect of tramadol is mediated through α-2-agonistic and serotoninergic activities. 4 It activates the opioid and non-opioid systems involved in pain inhibition. Tramadol is a unique analgesic with two modes of action. 2, 3 Non-opioid analgesics are generally used for this purpose after major surgery. 1 This approach is recommended by national guidelines and publications. Multimodal analgesic regimens use combinations of different analgesic drugs, methods to reduce pain after operation, or both while decreasing morphine use and its associated adverse effects. Tramadol can reduce opioid requirements after surgery, but this may not be clinically important. Small trials are unlikely to identify adverse effects of medications. Results of small trials conducted in a specific study population may not be generalizable. tramadol and morphine after surgery.Īdjunctive analgesics offer the possibility of reducing opioid-related side-effects. We found no significant clinical benefit from the combination of i.v. There was no decrease in pain intensity at 24 h the WMD was −0.9 (−7.2 5.2) on a 100 mm visual analogue scale at 24 h. No difference in the incidence of nausea, vomiting, sedation, or shivering was observed. This effect was not associated with a decrease in morphine-related adverse effects. There was a limited but significant postoperative morphine-sparing effect, with a weighted mean difference (WMD) of −6.9 (95% confidence interval −11.3 to −2.5) mg. Fourteen studies (713 patients) were included. We searched the MEDLINE, EMBASE, LILAC, Cochrane, and Clinical Trial Register databases for randomized, controlled studies comparing tramadol with placebo or active control in patients undergoing surgery. We undertook a systematic review to evaluate the utility of combining tramadol with morphine after surgery. The role for tramadol in multimodal postsurgical analgesic strategies remains unclear.