Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Abstract

Background Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.

Observation on the Effect of Rapid Rehabilitation Nursing with Integrated Medical Care in Perioperative Period of Laparoscopic Appendicitis in Children

“…Identifying ways to improve perioperative nursing is an urgent problem to be solved in clinical practice [19]. Research by foreign scholars has shown that the pain degree of adult patients after laparoscopic surgery is no less than that of knee replacement and thoracotomy [20,21]. Therefore, with the increasing number of laparoscopic surgeries, especially when the number of laparoscopic surgeries performed on children continues to rise, we must pay attention to the postoperative pain response.…”

A collaboration to improve perioperative acute pain care at the University Teaching Hospital of Butare, Rwanda

“…The focus on pain care effectiveness, implications for patient recovery, and recognition of pain management as a human right have become issues central to the discourse around equitable healthcare [1][2][3]. Providing effective perioperative pain care is a challenge in Africa and around the world [4][5][6][7].…”