title: Effect of combining tramadol and morphine in adult surgical patients: a systematic review and meta-analysis of randomized trials.
abstract: The role for tramadol in multimodal postsurgical analgesic strategies remains unclear. We undertook a systematic review to evaluate the utility of combining tramadol with morphine after surgery. 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. Fourteen studies (713 patients) were included. 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. This effect was not associated with a decrease in morphine-related adverse effects. No difference in the incidence of nausea, vomiting, sedation, or shivering was observed. 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. We found no significant clinical benefit from the combination of i.v. tramadol and morphine after surgery.
authors.affiliation: Service d'anesthésie, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, F-92380 Garches, France INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, F-92100, France Université Versailles Saint-Quentin, F-78035 Versailles, France valeria.martinez@rpc.aphp.fr.
authors.forename: V
authors.initials: V
authors.lastname: Martinez
authors.affiliation: Service d'anesthésie, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, F-92380 Garches, France.
authors.forename: L
authors.initials: L
authors.lastname: Guichard
authors.affiliation: Service d'anesthésie, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, F-92380 Garches, France INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, F-92100, France Université Versailles Saint-Quentin, F-78035 Versailles, France.
authors.forename: D
authors.initials: D
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D006801:Humans; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014147:Tramadol / Q000008:administration & dosage*
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine
keywords: balanced analgesia; meta-analysis; postoperative pain; surgery; tramadol