Analgesic efficacy and safety of single-dose tramadol and non-steroidal anti-inflammatory drugs in operations on the third molars: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate published randomised, double-blind, clinical trials to compare the analgesic efficacy and safety of tramadol with that of non-steroidal anti-inflammatory drugs (NSAID) in operations on the third molars. We identified eligible reports from searches of PubMed, MedLine, the Cochrane Library, Oxford Pain Relief database, Imbiomed, and Google Scholar. The full text of studies that met our minimum requirements were evaluated using inclusion and exclusion criteria with the Oxford Quality Scale. Those with a Score ≥ 3 in this scale were included and their data were extracted and analysed. Absolute increase in risk, the number needed to harm, odds ratio and 95% CI were calculated using Risk Reduction Calculator software. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, estimates of risk (odds ratio (OR)) and 95% CI were calculated using the Review Manager 5.2. from the Cochrane Library. A significant risk was assumed when the lower limit of the 95%CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that tramadol had less analgesic efficacy and an increased risk of adverse effects compared with NSAID. In conclusion, a single dose of tramadol was not as effective or as safe as NSAID for the relief of pain after operations on the third molars.