CLINICAL EFFICACY OF PRE-EMPTIVE TRAMADOL FOR POSTOPERATIVE PAIN CONTROL FOLLOWING MANDIBULAR THIRD MOLAR SURGERY: A SYSTEMATIC REVIEW AND METAANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background: Pre-emptive analgesia seeks to attenuate postoperative pain by limiting peripheral and central sensitization. Tramadol has been proposed as a pre-emptive option in mandibular third molar surgery, but its clinical effectiveness remains unclear. Objective: To evaluate the efficacy of pre-emptive tramadol for postoperative pain control following mandibular third molar surgery. Methods: A PRISMA-compliant systematic review of randomized controlled and split-mouth trials was conducted using PubMed/MEDLINE, Scopus, and EBSCOhost. Studies comparing pre-operative tramadol with placebo, NSAIDs, or combination regimens were included. Outcomes assessed were postoperative pain intensity, rescue analgesic use, total analgesic consumption, swelling, and trismus. Risk of bias was assessed using the Cochrane tool. Due to clinical heterogeneity, a qualitative synthesis with limited numerical analysis was performed. Results: Ten trials involving 459 patients were included. Tramadol monotherapy was inferior to NSAIDs in 70% of studies, showing higher pain scores and greater rescue analgesic requirements. One study reported comparable efficacy with nimesulide. In contrast, two trials demonstrated improved analgesia when tramadol was used as an adjunct to ketorolac. NSAIDs consistently provided superior control of postoperative inflammation. Conclusion: Pre-emptive tramadol alone is less effective than NSAIDs for postoperative pain control after mandibular third molar surgery. However, tramadol may offer additive benefit within multimodal analgesic regimens. It should not be recommended as a sole pre-emptive agent but may be considered as an adjunct in selected patients.