Dexamethasone Does Not Provide Additional Clinical Analgesia Effect to Local Wound Infiltration: A Comprehensive Systematic Review and Meta-Analysis

Ye, Xin; Ren, Yi-Feng; Hu, Yucheng; Tan, Shi-Yan; Jiang, Hua; Zhang, Longfei; Shi, Wei; Wang, Yuting

doi:10.1089/wound.2021.0163

Cited by 5 publications

(13 citation statements)

References 45 publications

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“…We estimated differences between pregabalin and the control group for pain scores and intravenous morphine equivalent consumption using the minimal clinically important difference (MCID). According to previous literature, a decrease of 1.1 cm and 10 mg, as well as a prolonged period of 1 h was considered as MCIDs for the pain scores, intravenous morphine equivalent consumption, and time to first analgesic request [ 43 , 44 , 45 ].…”

Section: Methodsmentioning

confidence: 99%

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

Wang

Dong

et al. 2023

Medicina

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Background and Objectives: As an adjunct to postoperative multimodal analgesic regimens, pregabalin has been reported in reducing postoperative acute pain and opioid consumption. However, there is only a small amount of evidence for preemptive pregabalin in patients undergoing cancer-related surgery. This systematic review was conducted to integrate high-quality evidence to evaluate the preemptive analgesic effects of pregabalin in cancer-related surgery. Materials and Methods: Seven electronic databases were searched in a combination of subject terms and free words. Efficacy and safety of preemptive pregabalin on postoperative pain for cancer-related surgery were evaluated by assessing resting and dynamic pain scores postoperatively, cumulative morphine equivalent consumption, time to first analgesic request, hemodynamic parameters, and the safety indicators. Results: Thirteen trials were incorporated for quantitative synthesis. The pooled results showed administration of pregabalin preoperatively is clinically significant for improving resting (weighted mean difference (WMD), −1.53 cm; 95% CI, −2.30 to −0.77) and dynamic (WMD, −1.16 cm; 95% CI, −2.22 to −0.11) pain severity scores at 2 h postoperatively and prolonging time to first analgesic request (WMD, 2.28 h; 95% CI, 0.79 to 3.77) in cancer-related surgery. Preemptive pregabalin was also statistically effective in some other pain indicators but would increase the risk of pregabalin-related side effects after surgery. Conclusions: Our findings do not support the administration of pregabalin in doses larger than 300 mg when put in cancer-related surgery. Taken together, more high-quality research particularly focused on the optimal dosages and timing of pregabalin in cancer-related surgery is needed in the future to establish stronger evidence for therapeutic effects.

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Section: Methodsmentioning

confidence: 99%

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

Wang

Dong

et al. 2023

Medicina

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“…The primary outcomes were calculated as a weighted mean difference (WMD) using a random‐effects model or fixed‐effects model with a 97.5% CI. A two‐sided P value < 0.025 was designated as the threshold of statistical significance to reduce type I error 3,24 . Continuous secondary outcomes, including rest and dynamic pain scores, length of hospital stay, and time to first analgesic, were expressed as the WMD with a 95% CI (two‐sided P < 0.05).…”

Section: Methodsmentioning

confidence: 99%

“…However, a major limitation of LA wound infiltration is the restricted duration of action when administered alone. To address this issue, several methods have been explored in recent years to prolong pain relief, including the use of new formulations (slow‐release formulations) and adjuvants to LAs 2‐4,6,7 . Regrettably, while multiple adjuvants such as dexamethasone, dexmedetomidine, and non‐steroidal anti‐inflammatory drugs have been proposed, the duration of action of drugs adjunct (Food and Drug Administration‐approved medication) to LA wound infiltration beyond 24 hours has not been conclusively proven 8 .…”

Section: Introductionmentioning

confidence: 99%

The effect of liposomal bupivacaine for surgical wound infiltration: A meta‐analysis of randomised controlled trials

Jiang

Dong

et al. 2022

International Wound Journal

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Liposomal bupivacaine (LB) has consistently been considered a potential analgesic for surgical wound infiltration. However, the evidence of its analgesic effectiveness remains unclear. In this meta‐analysis, we attempted to identify the potential clinical role of LB wound infiltration in different surgical procedures. Randomised controlled trials (RCTs) comparing LB with non‐liposomal local anaesthetics and placebos were retrieved from six electronic databases. The primary outcome was cumulative morphine equivalent consumption within 24, 48, and 72 hours after surgery. Approximately 2659 patients from 22 studies were included in the meta‐analysis. Compared to the control, LB‐wound infiltration did not reduce the postoperative morphine consumption at 24 hours (weighted mean difference [WMD], −0.60 mg; 97.5% confidence interval [CI], −2.78 to 1.59 mg; P = 0.54), 48 hours (WMD, −1.00 mg; 97.5% CI, −3.23 to 1.24; P = 0.32) or 72 hours (WMD, 0.50 mg; 97.5% CI, −0.67 to 1.67; P = 0.33). Similarly, secondary outcome analysis did not reveal any additional benefits of LB in any other pain‐related outcomes. LB was not associated with any adverse effects. Overall, LB does not appear to improve the postoperative analgesic, rehabilitation, or safety outcomes. Current evidence does not support the routine use of LB for wound infiltration following surgical procedures.

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“…The analysis of continuous variables used inverse variance weighted estimators, while the Mantel–Haenszel method was employed for dichotomous variables [ 30 ]. For our coprimary outcomes, the weighted mean difference (WMD) with a 99% CI was calculated to account for multiple comparisons [ 31 , 32 ]. The statistical significance level was set at two-sided p < 0.01 to reduce type I error.…”

Section: Methodsmentioning

confidence: 99%

“…The minimal clinically important difference (MCID) was set to determine the clinical significance of the outcomes. For the pain scores, an absolute change of 1.1 cm at a single time point was considered the MCID [ 32 ]. For the intravenous morphine equivalent consumption, an MCID threshold of 10 mg was defined as clinically significant [ 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials

An³

et al. 2022

Pain Ther

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Introduction:The administration of methylprednisolone (MP) is a component of perioperative multimodal analgesia that mitigates the potentially deleterious effects of postoperative pain and opioid consumption. However, a systematic evaluation of the efficacy and safety of MP is lacking. The present systematic review and meta-analysis was performed to quantify the potential clinical benefits and risks of perioperative MP in lung surgery. Methods: We searched seven electronic databases for randomized controlled trials (RCTs) comparing MP with placebo. Coprimary outcomes were rest pain scores, dynamic pain scores, and cumulative morphine equivalent consumption within 24 h postoperatively. Results: A total of 11 trials including 643 participants were selected for our meta-analysis. The results demonstrated that the MP group had a significant difference in coprimary outcomes (rest pain scores, dynamic pain scores, and cumulative morphine equivalent consumption) compared with the placebo group; nevertheless, the improvement was not clinically meaningful based on minimum clinically important differences (MCID). Notably, MP administration reduced serum levels of interleukin (IL)-6 at 6 h (weighted mean difference -20.49 pg/mL; 95% CI -29.94 to -11.04), and decreased the incidence rate of acute lung injury (rate ratio 0.18; 95% CI 0.03-0.98) and cognitive dysfunction (rate ratio 0.43; 95% CI 0.21-0.88) compared with the placebo group. Conclusions: Our findings suggest that the administration of MP contributed to an insignificant relief in acute postoperative pain for lung surgery in a clinical setting. Future studies should focus on exploring the role of MP in reducing pulmonary and surgical-related complications after lung surgery.Xi Fu and Xin Ye contributed equally as co-first authors.Yi-Feng Ren, Jing Dong, and Xin Ye contributed equally as co-correspondence authors.

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Dexamethasone Does Not Provide Additional Clinical Analgesia Effect to Local Wound Infiltration: A Comprehensive Systematic Review and Meta-Analysis

Cited by 5 publications

References 45 publications

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

A Meta-Analysis Showing the Quantitative Evidence Base of Preemptive Pregabalin for Postoperative Pain from Cancer-Related Surgery

The effect of liposomal bupivacaine for surgical wound infiltration: A meta‐analysis of randomised controlled trials

Efficacy and Safety of Methylprednisolone for Lung Surgery: a Systematic Review and Meta-analysis of Randomized Controlled Trials

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