Non-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis

Zhao, Huiying; Yang, Sui-Qin; Wang, Huixia; Zhang, Hua; An, Youzhong

doi:10.1016/j.jcrc.2019.08.022

Cited by 23 publications

(17 citation statements)

References 42 publications

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“…Our results are consistent with a recent meta-analysis that also aimed to summarize the use of nonopioid analgesics for ICU patients ( 53 ). In comparison to this review, our search was broader and included more citations, more eligible studies, and more potential adjunctive medications leading to more precise and clinically useful results.…”

Section: Discussionsupporting

confidence: 92%

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Wheeler

Centofanti

et al. 2020

Critical Care Explorations

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Section: Discussionsupporting

confidence: 92%

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Wheeler

Centofanti

et al. 2020

Critical Care Explorations

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“…This was done using standardized conversion methods, with input from content experts including critical care pharmacists. However, the differences in opioid types and regimens used in individual studies limit the ability to directly compare absolute opioid consumption between studies Our results are consistent with a recent meta-analysis that also aimed to summarize the use of nonopioid analgesics for ICU patients (53). In comparison to this review, our search was broader and included more citations, more eligible studies, and more potential adjunctive medications leading to more precise and clinically useful results.…”

Section: Discussionsupporting

confidence: 80%

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Wheeler

Martin

Centofanti

et al. 2019

D50. Critical Care: The Metamorphosis - Pain, Sedation, Delirium, Icu-Acquired Weakness, and Palliative Care

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Objectives: This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU. Data Sources: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science. Study Selection: Two independent reviewers screened citations. Eligible studies included randomized controlled trials comparing efficacy and safety of an adjuvant-plus-opioid regimen to opioids alone in adult ICU patients.Data Extraction: We conducted duplicate screening of citations and data abstraction. Data Synthesis: Of 10,949 initial citations, we identified 34 eligible trials. These trials examined acetaminophen, carbamazepine, clonidine, dexmedetomidine, gabapentin, ketamine, magnesium sulfate, nefopam, nonsteroidal anti-inflammatory drugs (including diclofenac, indomethacin, and ketoprofen), pregabalin, and tramadol as adjunctive analgesics. Use of any adjuvant in addition to an opioid as compared to an opioid alone led to reductions in patient-reported pain scores at 24 hours (standard mean difference, -0.88; 95% CI, -1.29 to -0.47; low certainty) and decreased opioid consumption (in oral morphine equivalents over 24 hr; mean difference, 25.89 mg less; 95% CI, 19.97-31.81 mg less; low certainty). In terms of individual medications, reductions in opioid use were demonstrated with acetaminophen (mean difference, 36.17 mg less; 95% CI, 7.86-64.47 mg less; low certainty), carbamazepine (mean difference, 54.69 mg less; 95% CI, 40.39-to 68.99 mg less; moderate certainty), dexmedetomidine (mean difference, 10.21 mg less; 95% CI, 1.06-19.37 mg less; low certainty), ketamine (mean difference, 36.81 mg less; 95% CI, 27.32-46.30 mg less; low certainty), nefopam (mean difference, 70.89 mg less; 95% CI, 64.46-77.32 mg less; low certainty), nonsteroidal anti-inflammatory drugs (mean difference, 11.07 mg less; 95% CI, 2.7-19.44 mg less; low certainty), and tramadol (mean difference, 22.14 mg less; 95% CI, 6.67-37.61 mg less; moderate certainty). Conclusions: Clinicians should consider using adjunct agents to limit opioid exposure and improve pain scores in critically ill patients.

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“…Together these findings suggest that ICU management of patients influences risk for persistent opioid prescription and may help identify patients at risk for chronic opioid use and misuse after hospital discharge. Reducing opioid exposure through use of non-opioid sedatives [18], multimodal analgesia [19] and limiting opioid prescription at discharge may play a key role in reducing the risk for chronic opioid dependence after TBI. This is consistent with the Society for Critical Care Medicine’s 2018 Clinical Practice Guidelines for Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep Disruption which recommend systemic assessment with validated pain and sedation scales to reduce opioid use, use of multimodal analgesia including non-opioid adjuncts and consideration of sedation agents, such as propofol or dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome

et al. 2019

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Traumatic brain injury (TBI) is associated with increased risk for psychological and substance use disorders. The study aim is to determine incidence and risk factors for persistent opioid prescription after hospitalization for TBI. Electronic medical records of patients age ≥ 18 admitted to a neuroscience intensive care unit between January 2013 and February 2017 for an intracranial injury were retrospectively reviewed. Primary outcome was opioid use through 12 months post-hospital discharge. A total of 298 patients with complete data were included in the analysis. The prevalence of opioid use among preadmission opioid users was 48 (87%), 36 (69%) and 22 (56%) at 1, 6 and 12-months post-discharge, respectively. In the opioid naïve group, 69 (41%), 24 (23%) and 17 (19%) were prescribed opioids at 1, 6 and 12 months, respectively. Preadmission opioid use (OR 324.8, 95% CI 23.1–16907.5, p = 0.0004) and higher opioid requirements during hospitalization (OR 4.5, 95% CI 1.8–16.3, p = 0.006) were independently associated with an increased risk of being prescribed opioids 12 months post-discharge. These factors may be used to identify and target at-risk patients for intervention.

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Non-opioid analgesics as adjuvants to opioid for pain management in adult patients in the ICU: A systematic review and meta-analysis

Cited by 23 publications

References 42 publications

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome

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