Efficacy and safety of tramadol in pain relief during diagnostic outpatient hysteroscopy: systematic review and meta-analysis of randomized controlled trials

The use of tramadol before diagnostic outpatient hysteroscopy, when indicated in patients with abnormal uterine bleeding or infertility, seems to be a safe and effective medication in reducing perceived pain.

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Volume 111, Issue 3, Pages 547–552


Omar M. Mattar, M.B., B.S., M.Ch., Ahmed R. Abdalla, M.B., B.S., M.Ch., Mohamed S.A. Shehata, M.B., B.S., M.Ch., Ahmed Said Ali, M.B., B.S., M.Ch., Muhammed Sinokrot, M.B., B.S., M.Ch., Bassant A. Abdelazeim, M.B., B.S., M.Ch., Ayman Taher, M.D., Ahmed Samy, M.D., Mostafa Mahmoud, M.D., Ahmed M. Abbas, M.D.



To evaluate the evidence about the safety and efficacy of tramadol in pain relief during diagnostic outpatient hysteroscopy (OH).


Systematic review and meta-analysis of randomized controlled trials.


Not applicable.


Patients undergoing diagnostic OH received tramadol versus those who were administered placebo.


Electronic databases were searched using the following MeSH terms (tramadol OR opioids OR opioid OR narcotic OR narcotics) AND (hysteroscopy OR hysteroscopic).

Main Outcome Measure(s)

Pain assessed by visual analogue scale (VAS) during OH, immediately and 30 minutes after the procedure.


One hundred thirteen studies were identified of which four randomized clinical trials were deemed eligible for this review (tramadol: n = 209; placebo: n = 209). The pooled estimate showed that tramadol significantly reduced VAS during procedure than placebo (weighted mean difference [WMD] = −1.33; 95% confidence interval [CI] −1.78 to −0.88, I2 = 3%, P = .36). In addition, tramadol significantly reduced VAS immediately after the procedure (WMD = −1.05; 95% CI −1.49 to −0.61, I2= 0, P = .84) and 30 minutes after (WMD = −0.98; 95% CI −1.30 to −0.65, I2 = 0, P = .88).


This meta-analysis suggests that tramadol is safe, effective, and gives favorable results in reducing pain during diagnostic OH.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.