Movement-Evoked Pain Versus Pain at Rest in Postsurgical Clinical Trials and Meta-Analyses: Protocol for a Follow-Up Systematic Review

Camiré, Daenis; Erb, Jason; Kehlet, Henrik; Brennan, Timothy J.; Gilron, Ian

doi:10.2196/15309

Cited by 7 publications

(5 citation statements)

References 9 publications

(17 reference statements)

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“…17 As MEP is commonly experienced during normal activities (e.g., breathing, coughing, and walking), it has a greater adverse impact on function and postoperative recovery than PAR. 5 Therefore, more attention should be given to MEP in postoperative analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Insu cient analgesia after surgery can cause chronic pain and impair quality of life; in addition, surgical stress and postoperative pain increase cortisol levels, which is one of the risk factors for postoperative delirium. 3,4 Currently, PAR draws much more attention than MEP, but MEP might cause poor outcomes, 5 such as postoperative atelectasis, thromboembolism and postoperative functional impairment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: A randomized controlled trial

Jiang

Liang

Sun

et al. 2023

Preprint

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Purpose: Postoperative pain and complications are still common after colorectal surgery, and pain can put patients in a stressful condition and precipitate complications. Thus, sufficient postoperative analgesia is essential for patient recovery. This study aimed to compare the efficacy of various postoperative analgesic strategies in laparoscopic colorectal surgery，and to elucidate whether systemic nalbuphine is a good choice for laparoscopic colorectal surgery. Patients and methods: One hundred patients undergoing laparoscopic colorectal cancer surgery were recruited, and 69 patients were eventually included and randomly divided into three groups: patient-controlled epidural analgesia (PCEA) with ropivacaine (Group R, n=23), patient-controlled intravenous analgesia (PCIA) with morphine (Group M, n=23) or nalbuphine (Group N, n=23). Pain at rest (PAR), movement-evoked pain (MEP), stress hormone and complications during the 72 hours after surgery, and chronic postsurgical pain (CPSP) at 3 months and 6 months were recorded. Results: There was no significant difference in PAR among the 3 groups, whereas patients in Group N had a higher intensity of MEP than those in Group R during the 72 hours after surgery (P<0.05). There was no significant difference in CPSP at 6 months among the 3 groups (P>0.05), but the incidence of CPSP at 3 months was higher in Group N (P=0.01, vs Group R), and CPSP at 3 months was closely correlated with MEP (P<0.05). There were no significant differences in cortisol and adrenocorticotropic hormone levels among the 3 groups (P>0.05). The incidences of pruritus and postoperative nausea and vomiting (PONV) were found to be significantly higher in Group M than in the other two groups (P<0.05). The time to the first flatus after surgery was shorter in Group R than in Group M or Group N (P<0.05). Conclusion: PCEA is the first choice for postoperative analgesia in laparoscopic colorectal surgery. Regarding the similar analgesic effect between morphine and nalbuphine, and the higher side effects from morphine, PCIA with nalbuphine might be a better choice in patients who have contraindications for PCEA or with a history of or a high risk for PONV or pruritus. Trial registration: This study was registered at http://www.chictr.org.cn/usercenter.aspx (registration No: ChiCTR-INR-17011092) on 08/04/2017.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: A randomized controlled trial

Jiang

Liang

Sun

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…15 As MEP is commonly experienced during normal activities (e.g., breathing, coughing, and walking), it has a greater adverse impact on function and postoperative recovery than PAR. 5 Therefore, more attention should be given to MEP in postoperative analgesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: A randomized controlled trial

Jiang

Liang

Sun

et al. 2022

Preprint

View full text Add to dashboard Cite

Purpose Postoperative pain and complications are still common after colorectal surgery, and pain can put patients in a stressful condition and precipitate complications. Thus, sufficient postoperative analgesia is essential for patient recovery. This study aimed to compare the efficacy of various postoperative analgesic strategies in laparoscopic colorectal surgery. Patients and methods: One hundred patients undergoing laparoscopic colorectal cancer surgery were recruited, and 69 patients were eventually included and randomly divided into three groups: patient-controlled epidural analgesia (PCEA) with ropivacaine (Group R, n = 23), patient-controlled intravenous analgesia (PCIA) with morphine (Group M, n = 23) or nalbuphine (Group N, n = 23). Pain at rest (PAR), movement-evoked pain (MEP), stress hormone and complications during the 72 hours after surgery, and chronic postsurgical pain (CPSP) at 3 months and 6 months were recorded. Results There was no significant difference in PAR among the 3 groups, whereas patients in Group N had a higher intensity of MEP than those in Group R during the 72 hours after surgery (P < 0.05). There was no significant difference in CPSP at 6 months among the 3 groups (P > 0.05), but the incidence of CPSP at 3 months was higher in Group N (P = 0.01, vs Group R), and CPSP at 3 months was closely correlated with MEP (P < 0.05). There were no significant differences in cortisol and adrenocorticotropic hormone levels among the 3 groups (P > 0.05). The incidences of pruritus and postoperative nausea and vomiting (PONV) were found to be significantly higher in Group M than in the other two groups (P < 0.05). The time to the first flatus after surgery was shorter in Group R than in Group M or Group N (P < 0.05). Conclusion PCEA is the first choice for postoperative analgesia in laparoscopic colorectal surgery. Regarding the similar analgesic effect between morphine and nalbuphine, and the higher side effects from morphine, PCIA with nalbuphine might be a better choice in patients who have contraindications for PCEA or with a history of or a high risk for PONV or pruritus. Trial registration: This study was registered at http://www.chictr.org.cn/usercenter.aspx (registration No: ChiCTR-INR-17011092) on April 8, 2017.

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“…Consistent with the original review, 14 the methods of this updated systematic review were described in a published review protocol 16 registered with PROSPERO (CRD42019125855). Procedures were guided by the principles of Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) 17 and A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2).…”

Section: Methodsmentioning

confidence: 99%

Movement-evoked Pain versus Pain at Rest in Postsurgical Clinical Trials and in Meta-analyses: An Updated Systematic Review

Gilron,

Lao,

Carley

et al. 2023

Anesthesiology

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Background Given the widespread recognition that postsurgical movement-evoked pain is generally more intense, and more functionally relevant, than pain at rest, the authors conducted an update to a previous 2011 review to re-evaluate the assessment of pain at rest and movement-evoked pain in more recent postsurgical analgesic clinical trials. Methods The authors searched MEDLINE and Embase for postsurgical pain randomized controlled trials and meta-analyses published between 2014 and 2023 in the setting of thoracotomy, knee arthroplasty, and hysterectomy using methods consistent with the original 2011 review. Included trials and meta-analyses were characterized according to whether they acknowledged the distinction between pain at rest and movement-evoked pain and whether they included pain at rest and/or movement-evoked pain as a pain outcome. For trials measuring movement-evoked pain, pain-evoking maneuvers used to assess movement-evoked pain were tabulated. Results Among the 944 included trials, 504 (53%) did not measure movement-evoked pain (vs. 61% in 2011), and 428 (45%) did not distinguish between pain at rest and movement-evoked pain when defining the pain outcome (vs. 52% in 2011). Among the 439 trials that measured movement-evoked pain, selection of pain-evoking maneuver was highly variable and, notably, was not even described in 139 (32%) trials (vs. 38% in 2011). Among the 186 included meta-analyses, 94 (51%) did not distinguish between pain at rest and movement-evoked pain (vs. 71% in 2011). Conclusions This updated review demonstrates a persistent limited proportion of trials including movement-evoked pain as a pain outcome, a substantial proportion of trials failing to distinguish between pain at rest and movement-evoked pain, and a lack of consistency in the use of pain-evoking maneuvers for movement-evoked pain assessment. Future postsurgical trials need to (1) use common terminology surrounding pain at rest and movement-evoked pain, (2) assess movement-evoked pain in virtually every trial if not contraindicated, and (3) standardize movement-evoked pain assessment with common, procedure-specific pain-evoking maneuvers. More widespread knowledge translation and mobilization are required in order to disseminate this message to current and future investigators. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Movement-Evoked Pain Versus Pain at Rest in Postsurgical Clinical Trials and Meta-Analyses: Protocol for a Follow-Up Systematic Review

Cited by 7 publications

References 9 publications

Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: A randomized controlled trial

Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: A randomized controlled trial

Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: A randomized controlled trial

Movement-evoked Pain versus Pain at Rest in Postsurgical Clinical Trials and in Meta-analyses: An Updated Systematic Review

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