Effect of Intra-Articular Tramadol versus Magnesium Sulfate on Post-Operative Pain of Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Farbood, Arash; Jowkar, Tahere; Sahmeddini, Mohammad Ali; Hashemi, Seyed Ali; Kanaani Nejad, Fatemeh; Banifatemi, Mahsa; Asmarian, Naeimehossadat; Saeedizadeh, Hamide; Chehelgerdi Samani, Sahar

doi:10.21608/egja.2025.366492.1028

Effect of Intra-Articular Tramadol versus Magnesium Sulfate on Post-Operative Pain of Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Document Type : Original Article

Authors

¹ Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

² Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

³ Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

⁴ Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

10.21608/egja.2025.366492.1028

Abstract

Objective
Effective management of postoperative pain is essential for promoting early recovery and rehabilitation after arthroscopic procedures. This study aimed to evaluate the impact of intra-articular tramadol and magnesium sulfate, in conjunction with pericapsular bupivacaine, on postoperative pain following knee arthroscopy.
Methods
We conducted a randomized clinical trial on 42 patients who were assigned to undergo arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee. Participants were randomly assigned to receive either 100mg of intra-articular tramadol combined with 1mg/kg of pericapsular bupivacaine (Tramadol group) or 1g of intra-articular magnesium sulfate along with 1mg/kg of pericapsular bupivacaine (Magnesium Sulfate group), both administered in equivalent volumes of 20mL. Postoperative assessments included the numeric rating scale for pain, the time until the first analgesic requirement, supplemental morphine consumption, patient satisfaction with pain control, and the incidence of side effects.
Results
After 24 hours of assessment, patients in the tramadol group reported significantly lower pain scores in the recovery room at 30-, 45-, and 60-minutes post-surgery (P= 0.002, P<0.001, and P= 0.001, respectively). Additionally, tramadol recipients required significantly less analgesia both in the ward and overall (P= 0.001 and P<0.001, respectively). There were no significant differences between the groups regarding side effects or patient satisfaction (P= 0.079).
Conclusions
Both intra-articular tramadol and magnesium sulfate are safe options; however, tramadol appears to provide superior pain control and reduce subsequent opioid use following knee arthroscopy.

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