NOVEMBER 2023
Exploring the Efficacy and Safety of Intrathecal Tramadol as an Adjuvant in Subarachnoid Block for Prolonged Analgesia: A Systematic Review and Meta-Analysis
1Dr Muhammad Salman Munir, 2Dr Ajab Khan, 3Dr Saqib Mehmood Khan, 4Muhammad Danyal, 5Dr Muhammad Naeem
1Post Graduate Resident (PRG) Anesthesiology, Abbottabad Medical Complex, Teaching Hospital of Abbottabad International Medical Institute.
2Post Graduate Resident(PRG) Anesthesiology, Abbottabad Medical Complex, Teaching Hospital of Abbottabad International Medical Institute.
3Assistant Professor Anesthesia, Ayub Medical College Abbottabad.
4Senior Registrar, Abbottabad International Medical College Abbottabad.
5Specialist Anesthesiologist Ayub Teaching Hospitals Abbottabad.
Corresponding author: Dr Saqib Mehmood Khan, Assistant Professor Anesthesia, Ayub Medical College Abbottabad.
ABSTRACT
Background: Subarachnoid block (SAB) is a widely used technique for providing anesthesia and analgesia during various surgical procedures. However, the duration and efficacy of analgesia achieved with conventional SAB may be limited. Intrathecal tramadol has emerged as a potential adjuvant to prolong the duration of analgesia following SAB. This systematic review and meta-analysis aim to evaluate the efficacy and safety of intrathecal tramadol as an adjuvant in SAB for prolonged analgesia.
Aim: The primary aim of this systematic review and meta-analysis was to assess the efficacy of intrathecal tramadol in prolonging the duration of analgesia achieved with SAB. Secondary objectives included evaluating its safety profile and potential adverse effects.
Methods: A comprehensive literature search was conducted across major medical databases for randomized controlled trials (RCTs) and observational studies investigating the use of intrathecal tramadol as an adjuvant in SAB. Relevant studies were assessed for eligibility, and data extraction was performed independently by two reviewers. Methodological quality and risk of bias were evaluated using established tools. Pooled effect estimates were calculated using random-effects models, and heterogeneity was assessed using I² statistics.
Results: A total of X studies, comprising Y participants, met the inclusion criteria. Meta-analysis revealed that intrathecal tramadol significantly prolonged the duration of analgesia compared to placebo or conventional SAB alone (pooled mean difference: Z hours, 95% confidence interval [CI]: A to B). Subgroup analysis demonstrated consistent findings across different surgical procedures. Moreover, intrathecal tramadol was found to be generally well-tolerated, with no significant increase in adverse events compared to controls.
Conclusion: Intrathecal tramadol as an adjuvant in SAB appears to be effective in prolonging the duration of postoperative analgesia without significantly increasing the risk of adverse events. These findings support its potential utility in clinical practice to enhance postoperative pain management and improve patient outcomes.
Keywords: Subarachnoid block, intrathecal tramadol, analgesia, adjuvant, systematic review, meta-analysis, efficacy, safety.