Development of evidence‐based recommendations for procedure‐specific pain management: PROSPECT methodology

Joshi, Girish P.; Velde, Marc Van de; Kehlet, Henrik; Pogatzki-Zahn, Esther; Schug, SA; Bonnet, Francis; Rawal, Narinder; Delbos, Alain; Lavand’homme, Patricia; Beloeil, Hélène; Ræder, Johan; Sauter, Axel R.; Albrecht, Éric; Lirk, Philipp; Lobo, David; Freys, Stephan M.

doi:10.1111/anae.14776

Cited by 101 publications

(213 citation statements)

References 30 publications

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“…The methods of this review adhered to the PROSPECT methodology as previously reported . Specific to this study, the EMBASE, MEDLINE, PubMed and Cochrane Databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Abstracts or Reviews of Effects, Cochrane Database of Systematic Reviews) were searched for RCTs published between 31 May 2006 and 15 October 2019.…”

Section: Methodsmentioning

confidence: 99%

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PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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Summary Analgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta‐analysis guidance with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty‐nine studies were found, of which 53 randomised controlled trials and nine meta‐analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra‐operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non‐steroidal anti‐inflammatory drugs) administered pre‐operatively or intra‐operatively and continued postoperatively. In addition, pre‐operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

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Section: Methodsmentioning

confidence: 99%

“…Quality assessment, data extraction and data analysis adhered to the PROSPECT methodology . Studies that reported pooled data from patients undergoing mixed procedures of cancer and non‐cancer breast surgery were excluded.…”

Section: Methodsmentioning

confidence: 99%

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2020

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“…The methods of this review adhered to PROSPECT methodology as previously reported . Specific to this study, the Embase, MEDLINE, PubMed and Cochrane Databases (Cochrane Central Register of Controlled Trials, Cochrane Database of Abstracts or Reviews of Effects, Cochrane Database of Systematic Reviews) were searched for RCTs published between 1 January 2006 and 15 April 2019.…”

Section: Methodsmentioning

confidence: 99%

“…Quality assessment, data extraction and data analysis adhered to PROSPECT methodology . Pain intensity scores were used as the primary outcome measure.…”

Section: Methodsmentioning

confidence: 99%

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

et al. 2019

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Summary Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol, cyclo‐oxygenase‐2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre‐operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α‐2‐adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra‐articular injection, and for surgical technique‐linked interventions, such as platelet‐rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non‐steroidal anti‐inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.

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“…The PECS‐2 or serratus plane block may provide analgesia for breast surgical procedures including axillary dissection, depending on the spread of the solution, but these blocks have never been properly studied in randomised controlled trials comparing them with standard analgesia, and consequently the PROSPECT methodology prevents us from recommending them at this time. We refer to our methodology paper published last year [3] and our website (http://www.postoppain.org) .…”

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confidence: 99%

Breast surgery analgesia: a reply

Lemoine¹,

Velde²,

Jacobs³

et al. 2020

Anaesthesia

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recommendations have been established on the basis of procedure-specific evidence of each intervention assessed. We agree that none of the regional anaesthetic techniques was proven to provide sufficient analgesia when used alone. This is why we recommended multimodal systemic analgesia. The evidence reported in the literature at the time led us to recommend paravertebral block for major breast surgery, and pectoral nerve blocks (PECS-2) as an alternative. The PECS-2 or serratus plane block may provide analgesia for breast surgical procedures including axillary dissection, depending on the spread of the solution, but these blocks have never been properly studied in randomised controlled trials comparing them with standard

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Development of evidence‐based recommendations for procedure‐specific pain management: PROSPECT methodology

Cited by 101 publications

References 30 publications

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for oncological breast surgery: a systematic review and procedure‐specific postoperative pain management recommendations

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

Breast surgery analgesia: a reply

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