title: Role of oral tramadol 50 mg in reducing pain associated with outpatient hysteroscopy: A randomised double-blind placebo-controlled trial.
abstract: BACKGROUND
  Several drugs have been used to reduce hysteroscopy-associated pain. Although the Royal College of Obstetricians and Gynaecologists has recommended against the use of opiates in outpatient hysteroscopy, we wished to investigate if opioids can be used if the appropriate opioid was given in the appropriate dose.
  
  
  OBJECTIVE
  To study the effectiveness of tramadol 50 mg in reducing pain associated with outpatient hysteroscopy.
  
  
  METHODS
  A prospective randomised double-blind placebo-controlled trial conducted in the outpatient hysteroscopy clinic at Cairo University Hospital. Main outcome measures were the severity of pain during the procedure, immediately after the procedure and 30 minutes later assessed by a visual analogue scale (VAS). VAS of 0 indicates no pain and VAS of 10 indicates the worst possible pain.
  
  
  RESULTS
  A total of 140 women who had diagnostic outpatient hysteroscopy were randomised to receive oral tramadol 50 mg or placebo one h before performing outpatient hysteroscopy. There was no difference between the groups in the age, parity, duration of the procedures or indications of hysteroscopy. The median pain score was significantly lower in the tramadol group during the procedure (5 vs 6; P = 0.013), immediately after the procedure (3 vs 4; P < 0.036), and 30 minute later (1 vs 2; P = 0.034). Two women in the tramadol group reported nausea, but this was mild and did not warrant cancelling the procedure.
  
  
  CONCLUSIONS
  Oral administration of tramadol 50 mg before hysteroscopy reduces the pain evoked by the procedure and the drug was well tolerated by women.
authors.affiliation: Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: AbdelGany
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.|Department of Obstetrics and Gynecology, University of Saarland, Homburg, Germany.
authors.forename: Hisham
authors.initials: H
authors.lastname: Haggag
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies; D014147:Tramadol / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol
keywords: hysteroscopy; pain; tramadol