Tramadol combined with local anesthesia for postoperative pain in third molar surgery.

Background: Postoperative pain is a significant challenge in oral surgery. Tramadol exhibits both systemic and local analgesic effects, with proven efficacy in combination with local anesthetics.

Purpose: This study evaluated the efficacy of local anesthetics combined with tramadol in reducing pain and analgesic use after third molar surgery.

Study design, setting, sample: This randomized, double-blind trial included ASA I-II patients aged 18-50 years and weighing 70-80 kg who were undergoing impacted third molar surgery. Patients requiring extra anesthesia, those with tramadol hypersensitivity, or those who recently used sedatives were excluded.

Independent variables: Two local anesthetic solutions were compared: the LT group (tramadol and articaine with epinephrine) and the LA group (articaine with epinephrine, control).

Main outcome variable: Postoperative pain was measured as the primary outcome via a visual analog scale (VAS) at multiple time points (10 min and 1, 2, 4, 6, 12, 24 and 48 h postsurgery). The secondary outcomes included the timing of the first analgesic intake and the total number of analgesic doses consumed within 48 h.

Covariates: The covariates included age, sex, BMI, surgical duration, and adverse effects (nausea, vomiting, burning).

Analyses: Age and surgical duration were analyzed with t tests; VAS scores and analgesic use were analyzed with Mann-Whitney U tests; and categorical data were analyzed with Fisher's exact test or Yates' correction (p < 0.01).

Results: Sixty patients were randomized into the LT (n = 30) and LA (n = 30) groups. Age, sex, and BMI distributions were similar between the groups. VAS pain scores were lower in the LT group at 1, 2, and 6 h (mean difference: -4.9, -1.9, and - 1.4; p < 0.01) but higher at 4 h (mean difference: 1.5; p < 0.01). The LT group required their first analgesic later (5.2 ± 0.8 vs. 2.0 ± 0.6 h; mean difference: 3.1; p < 0.01) and consumed fewer analgesics (1.8 ± 0.5 vs. 3.6 ± 0.8 doses; mean difference: -1.8; p < 0.01). A transient higher VAS score was observed at 4 h in the LT group, likely reflecting delayed analgesic use. Adverse effects were minimal and not significantly different between groups.

Conclusion and relevance: Local anesthetics combined with tramadol reduce pain and analgesic use after third molar surgery. This strategy improves recovery and warrants further research for broader applications.

Trial registration: ClinicalTrials.gov NCT05614440, Date of registration 14 November 2022.