Postarthroscopic meniscectomy: intra-articular injection of tramadol: is it superior to intra-articular fentanyl?

Purpose To compare the effect of intra-articular (IA) tramadol (100 mg) versus fentanyl (0.1 mg) as postoperative analgesic after arthroscopic meniscectomy. Methods This was a randomized, double-blind, controlled trial including 60 ASA I–II patients undergoing arthroscopic meniscectomy under general anesthesia. At the end of the surgical procedure, patients were randomly allocated to one of three equal groups using the sealed envelope method. The control group (group C) received an IA injection of methyl-prednisolone acetate 40 mg, the fentanyl group (group F) received fentanyl 0.1 mg and methyl-prednisolone acetate 40 mg, and the tramadol group (group T) received tramadol 100 mg and methyl-prednisolone acetate 40 mg. Postoperative pain was assessed using the visual analogue scale (VAS) at 30 min, 2, 4, 8, 12, and 24 h at rest. Analgesic duration (time to first request for analgesics), analgesic consumption in the first 24 h, and the incidence of postoperative nausea and vomiting were recorded. Results The VAS scores were significantly lower in groups F and T compared with group C (P 0.001) at 30 min, 2, 4, 8, 12, and 24 h and in group T compared with group F at 8, 12, and 24 h after the operation (P 0.05). Time to first morphine dose was significantly lower in group C compared with groups F and T (P 0.001), and in group F compared with group T (P 0.001). The frequency of morphine doses in the first 24 h was significantly higher in group C compared with groups F and T (P 0.001), and in group F compared with group T (P=0.003). There were no statistically significant differences between groups in postoperative nausea and vomiting in the first 2 postoperative hours (P=0.766). Conclusion An IA injection of tramadol 100 mg following arthroscopic meniscectomy is a good option for postoperative pain control, with superior analgesic properties than fentanyl (0.1 mg) in terms of lower VAS scores and lesser need for postoperative systemic analgesics.