Pharmacological interventions for improving the postoperative pain intensity in adults after opioid-based anesthesia: a systematic review and network meta-analysis

Abstract

Background: Opioid-induced hyperalgesia (OIH) is an adverse event after exposure to opioids which would increase pain intensity. The optimal drug to prevent these adverse effects is still unclear. We aimed to perform a network meta-analysis to compare different pharmacological interventions in preventing the increase in postoperative pain caused by OIH. Methods: Several databases were searched independently for randomized-controlled trials (RCTs) comparing different pharmacological interventions in preventing OIH. The primary outcomes were postoperative pain intensity at rest at 24h and the incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included pain thresholds at 24h after surgery, cumulative morphine consumption over 24h, time to first postoperative analgesic requirement, and the incidence of shivering. Results: In all, 33 RCTs comprising 1711 patients were identified. In terms of postoperative pain intensity, amantadine, magnesium sulphate, pregabalin, dexmedetomidine, ibuprofen, flurbiprofen plus dexmedetomidine, parecoxib, parecoxib plus dexmedetomidine, and S (+)-ketamine plus methadone were associated with milder pain intensity than placebo, with amantadine ranked the most effective (SUCRA values =96.2). In terms of the incidence of PONV, intervene with dexmedetomidine or flurbiprofen plus dexmedetomidine means a lower incidence placebo and dexmedetomidine showed the best result (SUCRA values =90.3). Conclusions: Amantadine was identified as the best in postoperative pain intensity as well as non-inferior to placebo in the incidence of PONV. Dexmedetomidine was the only intervention that is superior to placebo in all indicators.

Trajectory of pain threshold and its association with acute pain after thoracic surgery: a prospective observational study

“…Previous studies have shown that use of high-dose remifentanil and fentanyl can result in hyperalgesia [16,20]. However, recent studies have demonstrated that dexmedetomidine infusion can reduce opioid-induced hyperalgesia [21,22]. Third, the timing of PT measurement differs among studies.…”

Treating pain in patients with Ehlers–Danlos syndrome

“…In the authors' view, it is advisable to critically examine the individual constellation before and during opioid therapy. Furthermore, it is known that the long-term use of opioids can significantly contribute to central sensitization [5,44], which is a relevant factor in EDS patients anyway [11]. Indeed, approaches with opioid-free anesthesia in patients in general [45], but also in hypermobile patients, resulted in reduced postoperative pain levels [46].…”

Remifentanil-induced hyperalgesia: the current state of affairs

“…It appears to be a consensus that lower opioid doses and gradual dose tapering will decrease the incidence and severity of OIH [42,44]. Nonopioid analgesic adjuncts and dexmedetomidine also appear to have some utility in the prevention of OIH [45 ▪▪ ] as do magnesium infusions and co-administration with propofol (rather than inhalation anesthetics) [41].…”