Opioid versus opioid-free analgesia after surgical discharge: a systematic review and meta-analysis of randomised trials

Fiore, Julio F.; El-Kefraoui, Charbel; Chay, Marc-Aurèle; Nguyen-Powanda, Philip; Do, Uyen; Olleik, Ghadeer; Rajabiyazdi, Fateme; Kouyoumdjian, Araz; Derksen, Alexa; Landry, Tara; Amar‐Zifkin, Alexandre; Bergeron, Amy; Ramanakumar, Agnihotram V.; Martel, Marc O.; Lee, Lawrence; Baldini, Gabriele; Feldman, Liane S.

doi:10.1016/s0140-6736(22)00582-7

Cited by 53 publications

(42 citation statements)

References 108 publications

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“…1 Given that pain is a product of biopsychosocial factors, multimodal environmental enrichment, incorporating various non-pharmacological analgaesic approaches, 2 may be effective in reducing postoperative pain. 3 In the post-discharge setting the role of pharmacological means of pain control, in particular opioids, are questionable, 4 making optimisation of non-pharmacological factors crucial.…”

Section: Introductionmentioning

confidence: 99%

Language and gender barriers to pain control after general surgery

Kovoor

Bacchi

Stretton

et al. 2022

ANZ Journal of Surgery

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Background Effective pain control is crucial to postoperative recovery and is affected by biopsychosocial factors. This study aimed to evaluate how non‐English primary language, gender, and marital status may influence pain, length of stay, and mortality after general surgery. Methods Consecutive general surgical admissions over a two‐year period to two tertiary hospitals were included. Multivariable logistic regression analyses were conducted to evaluate the relationship between non‐English primary language, gender, and marital status, and pain scores, length of stay, and in‐hospital mortality. Explanatory variables that were controlled for in these analyses included age, birth country, whether a religion was specified, socioeconomic percentile, Charlson comorbidity index, and time of admission. Results A total of 12 846 general surgery patients were included. When controlling for the aforementioned variables, including having a specified religion and being born overseas, having a non‐English primary language was significantly independently associated with lower pain scores (odds ratio 0.61, 95% CI 0.52–0.71, P < 0.001). Female gender was independently associated with an increased likelihood of higher pain scores (odds ratio 1.09, 95% CI 1.01–1.18, P = 0.024) and a lower likelihood of prolonged length of stay (odds ratio 0.88, 95% CI 0. 80–0.95, P = 0.002). None of the evaluated variables had a statistically significant association with in‐hospital mortality. Conclusions This study is the first to characterize an association between general surgery patients with a non‐English primary language and lower levels of postoperative pain. It was also found that female gender was associated with higher postoperative pain but lower length of hospital stay.

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Section: Introductionmentioning

confidence: 99%

Language and gender barriers to pain control after general surgery

Kovoor

Bacchi

Stretton

et al. 2022

ANZ Journal of Surgery

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“…Opioid-free or low-opioid analgesia after surgery has become an important perioperative issue [ 71 , 72 ]. Through the comparison of opioid and non-opioid analgesia after discharge from the hospital, we can find that opioid-free analgesia leads to numerous favorable prognostic events for patients [ 73 , 74 ]. We chose 24 h morphine consumption as the primary outcome of this study to explore which treatment can reduce morphine consumption to the greatest extent.…”

Section: Discussionmentioning

confidence: 99%

Regional block techniques for pain management after video-assisted thoracoscopic surgery: a covariate-adjusted Bayesian network meta-analysis.

Jiang¹,

Mo²,

Zhan³

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction: Nerve block is widely used for pain management after video-assisted thoracoscopic surgery (VATS). Thoracic paravertebral block (TPVB), erector spinae plane block (ESPB), serratus anterior plane block (SAPB), and intercostal nerve block (ICNB) are alternative treatments. Material and methods: Network meta-analysis based on Bayesian analyses was performed to obtain results for direct comparison, indirect comparison, and network comparison, and to make rankings based on probabilities. Covariates were adjusted to determine the effect of the covariates on results of this study.Results: The study identified 61 randomized controlled trials (RCTs) (4468 patients). There were results of probability ranking for the first ("best" treatment): 24 h morphine consumption, TPVB > ESPB > ICNB > SAPB. Covariate adjustment allowed the four treatments to change somewhat in the likelihood of the best choice. Conclusions: TPVB ranks best in our analysis. ESPB is a viable alternative. SAPB and ICNB seem to play a limited role in postoperative pain management.

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“…1,13 Central 14 and efferent (vagal) 15 components of the baroreflex may therefore reduce pain after major surgery for trauma, which potentially limits the adverse effects of opioid prescribing. 16 Autonomic neuromodulation using transcutaneous auricular nerve stimulation may reduce pathological pain, but the observed effects in models of evoked pain are variable. Notably, there is a paucity of interventional studies that specifically investigate the correlation between acute pain and autonomic measures.…”

Section: Editor's Key Pointsmentioning

confidence: 99%