Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis

Anaesthesia
J FrauenknechtE Albrecht

Abstract

Opioids are administered peri-operatively for postoperative analgesia, and intra-operatively to control the sympathetic response to surgical stimuli, frequently as a surrogate for presumed pain. However, opioid use during surgery is a matter of dispute in contemporary practice and carries the risk of side-effects such as postoperative nausea and vomiting. This meta-analysis investigated whether opioid-inclusive, compared with opioid-free anaesthesia, would reduce postoperative pain, without increasing the rate of postoperative nausea and vomiting. The electronic databases Medline and PubMed were searched until June 2018. We included trials investigating pain outcomes and comparing any type of intra-operative opioid administration with placebo injection or no intra-operative opioid. Most meta-analyses were performed using a random effects model. We rated the quality of evidence for each outcome. The primary outcome was pain score at rest (analogue scale, 0-10) at two postoperative hours. Our secondary outcomes included the rate of postoperative nausea and vomiting within the first 24 postoperative hours and length of stay in the recovery area. Twenty-three randomised controlled trials, including 1304 patients, were identified. P...Continue Reading

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Citations

Feb 26, 2019·Anaesthesia·N M Elkassabany, E R Mariano
Aug 7, 2019·Anaesthesia·H BeloeilV Martinez
Jun 13, 2020·Current Opinion in Anaesthesiology·Pamela A ChiaChristine C Myo Bui
Sep 30, 2020·Anesthesiology·Harsha ShanthannaGirish P Joshi
Jul 1, 2020·Regional Anesthesia and Pain Medicine·Katarzyna Korwin-KochanowskaUNKNOWN PROSPECT/ESRA Working Group Collaboration
Jun 23, 2020·Perioperative Medicine·Sushan GuptaVijaya Gottumukkala
Aug 7, 2019·Anaesthesia·E Albrecht, K R Kirkham
Sep 6, 2020·Anesthesia and Analgesia·Michael C GrantViachaslau Barodka
Jan 12, 2021·Anaesthesia·D F Johnston, L R Turbitt
Jan 12, 2021·Anaesthesia·N Levy, P Lirk
Jul 20, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Gary DevineAndrew Roscoe
May 22, 2020·Journal of Cardiothoracic and Vascular Anesthesia·Antonio PisanoGiovanni Landoni
Feb 11, 2021·Plastic and Reconstructive Surgery. Global Open·Percy Rossell-PerryRenato Marca-Ticona
Feb 18, 2021·Deutsches Ärzteblatt International·Felix BartholmesChristine H Meyer-Frießem
Aug 6, 2020·Minerva anestesiologica·Dario BugadaPatricia Lavand'homme
Mar 14, 2021·British Journal of Anaesthesia·Felipe P RangelClaudia M Simões
Apr 16, 2021·Anaesthesia·E Albrecht, C M Brummett
Dec 2, 2019·Best Practice & Research. Clinical Anaesthesiology·Helene Beloeil
Jun 12, 2021·The American Surgeon·Elizabeth M BoudiabSapna Nagar
Jun 15, 2021·The Cochrane Database of Systematic Reviews·Brett DolemanJohn P Williams

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