Efficacy of intravenous tramadol treatment for reducing pain during office diagnostic hysteroscopy

Objective: To assess whether IV tramadol before outpatient hysteroscopy could reduce procedure-related pain. Design: A randomized double-blind placebo controlled trial. Setting: Outpatient Hysteroscopy Centre in the Department of Obstetrics and Gynaecology of Cagliari University. Patient(s): Fifty healthy, parous, women who underwent outpatient diagnostic hysteroscopy and endometrial biopsy. Intervention(s): Random IV infusion of tramadol or placebo before hysteroscopy and endometrial biopsy were performed. Main Outcome Measure(s): Visual analogue scale of pain was measured both immediately after and 15 minutes after the procedure. Stress hormones (ACTH, cortisol), blood pressure, and heart frequency were evaluated before, during, and 15 minutes after the procedure. Result(s): In the tramadol group, the visual analogue scale of pain was significantly lower than in the placebo group both immediately after the procedure and 15 minutes later. Basal levels of ACTH and cortisol did not differ between the groups. In both groups, the ACTH levels remained unchanged during the study, and the cortisol levels were higher 15 minutes after the procedure than before the procedure. Procedure time, heart frequency, blood pressure, and adverse effects did not differ between the groups. Conclusion(s): In parous women without uterine malformations, a treatment with tramadol before hysteroscopy and endometrial biopsy appears to be capable of reducing the pain and discomfort that are associated with this procedure.