The effect of triple vs. double nonopioid therapy on postoperative pain and functional outcome after abdominal hysterectomy

Gilron, Ian; Tu, Dongsheng; Dumerton-Shore, Deborah; Scott, D. W.; Rooney, Rachel; McGrath, Michael; Orr, Elizabeth

doi:10.1097/eja.0000000000000190

Cited by 11 publications

(4 citation statements)

References 20 publications

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“…A 2009 study by Gilron et al found no benefit to the combination of meloxicam and gabapentin versus gabapentin alone in patients undergoing laparoscopic cholecystectomy, 62 and a 2015 study by the same group examining triple versus double nonopioid therapy for open abdominal hysterectomy found no improvement with a third nonopioid adjunct. 63 Polypharmacy has known dangers, especially in geriatric populations, where cohort studies have demonstrated polypharmacy as a risk factor for delirium 64 ; also, as cited earlier, gabapentin has been implicated in respiratory depression, especially in older patients. 29 Further research is necessary to clarify the benefits-and risks-of combining several multimodal techniques into a single protocol.…”

Section: Combining Multimodal Therapiesmentioning

confidence: 89%

Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Simpson

Bao

Agarwala

2019

Clinics in Colon and Rectal Surgery

155

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Pain control is an integral part of Enhanced Recovery after Surgery (ERAS) protocols for colorectal surgery. While opioid therapy remains the mainstay of therapy for postsurgical pain, opioids have undesired side effects including delayed recovery of bowel function, respiratory depression, and postoperative nausea and vomiting. A variety of nonopioid systemic medical therapies as well as regional and neuraxial techniques have been described as improving pain control while reducing opioid use. Multimodal and preemptive analgesia as part of an ERAS protocol facilitates early mobility and early return of bowel function and decreases postoperative morbidity. In this review, we examine several multimodal therapies and their impact on postoperative analgesia, opioid use, and recovery for patients undergoing colorectal surgery.

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Section: Combining Multimodal Therapiesmentioning

confidence: 89%

Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Simpson

Bao

Agarwala

2019

Clinics in Colon and Rectal Surgery

155

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“…No previous study met the methodological requirements to be included in the most recent network meta-analysis on the subject. 7 Gilron and colleagues 8 failed to demonstrate a benefit with the addition of a third NOA to double-drug regimens, including acetaminophen, meloxicam, and gabapentin. In the present study, we showed that three NOAs, including one NSAID, allowed a significant reduction in morphine consumption.…”

Section: Discussionmentioning

confidence: 99%

Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

Beloeil

Albaladéjo

Sion

et al. 2019

British Journal of Anaesthesia

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“…Sufficient treatment of postoperative pain is of utmost importance, consequently improving postoperative mortality and rehabilitation and precipitate return of mobilization and early discharge 2 . Postoperative pain is the most predictable type of acute pain, 5 but no single drug or intervention is able to provide adequate relief without major surveillance, equipment and adverse effects 6 . The basic analgesic regimen for postoperative pain management should ideally be composed of combinations of drugs possessing two essential properties: (a) analgesic efficacy lowering subjective experience of pain; and (b) safety when used, hence exert the desired effect without any adverse effects causing harm or discomfort to the recipient.…”

Section: Introductionmentioning

confidence: 99%

Paracetamol, non‐steroidal anti‐inflammatory drugs and glucocorticoids for postoperative pain: A protocol for a systematic review with meta‐analysis and trial sequential analysis

Stormholt

Steiness

Derby

et al. 2021

Acta Anaesthesiol Scand

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Background Multimodal analgesia is the leading principle for managing postoperative pain. Recent guidelines recommend combinations of paracetamol and a non‐steroidal anti‐inflammatory drug (NSAID) for most surgeries. Glucocorticoids have been used for decades due to their potent anti‐inflammatory and antipyretic properties. Subsequently, glucocorticoids may improve postoperative analgesia. We will perform a systematic review to assess benefits and harms of adding glucocorticoids to paracetamol and NSAIDs. We expect to uncover pros and cons of the addition of glucocorticoid to the basic standard regimen of paracetamol and NSAIDs for postoperative analgesia. Method This protocol for a systematic review was written according to the The Preferred Reporting Items for Systematic Review and Meta‐Analysis Protocols guidelines. We will search for trials in the following electronic databases: Medline, CENTRAL, CDSR and Embase. Two authors will independently screen trials for inclusion using Covidence, extract data and assess risk of bias using Cochrane's ROB 2 tool. We will analyse data using Review Manager and Trial Sequential Analysis. Meta‐analysis will be performed according to the Cochrane guidelines and results will be validated according to the eight‐step procedure suggested by Jakobsen et al We will present our primary findings in a ‘summary of findings’ table. We will evaluate the overall certainty of evidence using the GRADE approach. Discussion This review will aim to explore the combination of glucocorticoids together with paracetamol and NSAIDs for postoperative pain. We will attempt to provide reliable evidence regarding the role of glucocorticoids as part of a multimodal analgesic regimen in combination with paracetamol and NSAID.

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The effect of triple vs. double nonopioid therapy on postoperative pain and functional outcome after abdominal hysterectomy

Abstract: International Standard Randomised Controlled Trial Number Register 12723675.

Cited by 11 publications

References 20 publications

Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Pain Management in Enhanced Recovery after Surgery (ERAS) Protocols

Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

Paracetamol, non‐steroidal anti‐inflammatory drugs and glucocorticoids for postoperative pain: A protocol for a systematic review with meta‐analysis and trial sequential analysis

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