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.

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

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2025年10月14日

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İbrahim Murat Afat,
Onur Gönül,
Tülin Satılmış

摘要

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.