Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta‐analysis

Abstract

Preoperative administration of pharmacological substances, such as nonsteroidal anti-inflammatory drugs or opioids, has been gaining acclaim as a preemptive measure to minimize postoperative pain. This systematic review and meta-analysis aimed at evaluating the effectiveness of this approach in adults undergoing surgical procedures. MEDLINE, EMBASE and the Cochrane Central Register were searched from inception through January 2015. Data from randomized placebo-controlled trials were screened, extracted and assessed for risk of bias according to The Cochrane Collaboration's Tool by two independent authors. The primary outcome measure was reduction in postoperative analgesic consumption during 24 h post surgery; effects were described as mean differences between the drug and placebo arms with corresponding 95% confidence intervals (CIs) and were pooled using random-effects models. Potential publication bias was tested using funnel plots and Egger's regression test for funnel plot asymmetry. Screened were 511 records, of which 39 were included in the final synthesis with data from 3172 patients. A significant reduction in postoperative analgesic consumption was observed using preoperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs; 95% CI, À0.61 to À0.14; 31 comparisons), chiefly by the COX-2 inhibitors class (95% CI, À0.95 to À0.33; 13 comparisons). Significant reduction was also observed for gabapentin (95% CI, À1.60 to À0.38; 6 comparisons). No significant effects were observed using opioids, propionic acids or oxicam derivatives. What does this review add?: Current analyses endorse the effectiveness of COX-2 inhibitors and gabapentin in reducing acute postoperative pain when administered preemptively presurgery. Such corroboration is not found for opioids and other NSAID classes.

Perioperative pain management strategies among women having reproductive surgeries

“…They have been demonstrated to improve pain control for many surgical procedures. Though there is a theoretical concern due to their effect on platelet function, evidence suggests that the use of NSAIDs generally does not increase the risk for periprocedural bleeding (7,8). …”

Evaluation of Pain Management after Surgery: An Observational Study

“…The most commonly used drugs in the treatment of postoperative pain included nonsteroidal anti-inflammatory drugs (NSAIDs) as well as opioids, in combination with various methods of local anesthesia, e.g., infiltration and spinal methods [1][2][3]. In postoperative pharmacotherapy, various methods of drug administration are used, e.g., doses at the patient's request, continuous opioid infusion, patient-controlled analgesia (PCA), epidural, peripheral blocks, preventive analgesia, and analgosedation [4,5]. Effective pain management reduces the stress response, facilitates mobilization, improves the quality of the postoperative period, and influences the resumption of oral nutrition.…”

Comparison of postoperative analgesic efficacy of preemptive USG-guided TAP block, USG-guided local infiltration and intravenous dexketoprofen in inguinal hernia repair

“…This may increase the length of hospital stay and hospital costs. Therefore, effective postoperative analgesia management may enable the patient to return to his / her daily life early and to reduce health costs [4].…”