Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence.
acute pain
hepatectomy
liver resection
pain management
postoperative pain
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
18 Aug 2021
18 Aug 2021
Historique:
received:
13
06
2021
revised:
07
08
2021
accepted:
13
08
2021
entrez:
27
8
2021
pubmed:
28
8
2021
medline:
28
8
2021
Statut:
epublish
Résumé
The existing recommendations for after open liver surgery, published in 2019, contains limited evidence on the use of regional analgesia techniques. The aim of this systematic review is to summarize available clinical evidence, published after September 2013, on systemic or blended postoperative analgesia for the prevention or treatment of postoperative pain after open liver surgery. The PUBMED and EMBASE registries were used for the literature search to identify suitable studies. Keywords for the literature search were selected, with the authors' agreement, using the PICOS approach: participants, interventions, comparisons, outcomes, and study design. The literature search led to the retrieval of a total of 800 studies. A total of 36 studies including 25 RCTs, 5 prospective observational, and 7 retrospective observational studies were selected as suitable for this systematic review. The current evidence suggests that, in these patients, optimal postoperative pain management should rely on using a "blended approach" which includes the use of systemic opioids and the infusion of NSAIDs along with regional techniques. This approach warrants the highest efficacy in terms of pain prevention, including the lower incretion of postoperative "stress hormones", and fewer side effects. Furthermore, concerns about the potential for the increased risk of wound infection related to the use of regional techniques have been ruled out.
Sections du résumé
BACKGROUND
BACKGROUND
The existing recommendations for after open liver surgery, published in 2019, contains limited evidence on the use of regional analgesia techniques. The aim of this systematic review is to summarize available clinical evidence, published after September 2013, on systemic or blended postoperative analgesia for the prevention or treatment of postoperative pain after open liver surgery.
METHODS
METHODS
The PUBMED and EMBASE registries were used for the literature search to identify suitable studies. Keywords for the literature search were selected, with the authors' agreement, using the PICOS approach: participants, interventions, comparisons, outcomes, and study design.
RESULTS
RESULTS
The literature search led to the retrieval of a total of 800 studies. A total of 36 studies including 25 RCTs, 5 prospective observational, and 7 retrospective observational studies were selected as suitable for this systematic review.
CONCLUSIONS
CONCLUSIONS
The current evidence suggests that, in these patients, optimal postoperative pain management should rely on using a "blended approach" which includes the use of systemic opioids and the infusion of NSAIDs along with regional techniques. This approach warrants the highest efficacy in terms of pain prevention, including the lower incretion of postoperative "stress hormones", and fewer side effects. Furthermore, concerns about the potential for the increased risk of wound infection related to the use of regional techniques have been ruled out.
Identifiants
pubmed: 34441958
pii: jcm10163662
doi: 10.3390/jcm10163662
pmc: PMC8397227
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Références
Rev Assoc Med Bras (1992). 2018 Feb;64(2):175-180
pubmed: 29641671
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
J Surg Oncol. 2019 Jan;119(1):47-55
pubmed: 30481374
J Anesth. 2016 Feb;30(1):39-46
pubmed: 26511998
HPB (Oxford). 2014 Aug;16(8):768-75
pubmed: 24467320
Ann Surg. 2017 Sep;266(3):545-554
pubmed: 28746153
HPB (Oxford). 2014 Jul;16(7):601-9
pubmed: 24151899
Med Sci Monit. 2019 Feb 07;25:1053-1060
pubmed: 30730866
Ann Surg. 2019 Aug;270(2):200-208
pubmed: 31058695
Anesth Analg. 2018 Apr;126(4):1142-1147
pubmed: 28922227
BMJ. 2009 Jul 21;339:b2700
pubmed: 19622552
Liver Transpl. 2015 Apr;21(4):478-86
pubmed: 25546011
BMC Anesthesiol. 2019 Feb 18;19(1):23
pubmed: 30777027
ANZ J Surg. 2018 Dec;88(12):1236-1242
pubmed: 29534349
Pain Pract. 2017 Sep;17(7):968-981
pubmed: 27996204
Reg Anesth Pain Med. 2009 Jul-Aug;34(4):308-11
pubmed: 19574863
Mayo Clin Proc Innov Qual Outcomes. 2018 May 02;2(2):186-193
pubmed: 30225448
Chin Med Sci J. 2017 Sep 27;32(3):171-176
pubmed: 28956744
BMC Med Inform Decis Mak. 2007 Jun 15;7:16
pubmed: 17573961
Medicine (Baltimore). 2020 Jul 31;99(31):e20042
pubmed: 32756071
World J Surg. 2020 Jul;44(7):2340-2349
pubmed: 32112166
Can J Anaesth. 2001 Nov;48(10):1000-10
pubmed: 11698320
Transplant Proc. 2017 Mar;49(2):309-315
pubmed: 28219590
Medicine (Baltimore). 2017 Apr;96(15):e6624
pubmed: 28403113
Eur J Anaesthesiol. 2008 Apr;25(4):267-74
pubmed: 18053314
Cochrane Database Syst Rev. 2018 Aug 30;8:CD010434
pubmed: 30161292
J Anesth. 2017 Apr;31(2):237-245
pubmed: 27885425
Surgery. 2018 Dec;164(6):1251-1258
pubmed: 30201232
Anesth Analg. 2003 Aug;97(2):534-40, table of contents
pubmed: 12873949
Open J Anesthesiol. 2013 Jan 1;3(1):3-7
pubmed: 25580374
J Pain. 2016 Feb;17(2):131-57
pubmed: 26827847
Anaesth Intensive Care. 2006 Aug;34(4):438-43
pubmed: 16913338
Ann Surg. 2019 Aug;270(2):193-199
pubmed: 30676382
Minerva Anestesiol. 2015 May;81(5):541-56
pubmed: 24918191
Anesthesiology. 2006 Mar;104(3):594-600
pubmed: 16508407
Adv Surg. 2018 Sep;52(1):235-246
pubmed: 30098615
World J Gastroenterol. 2017 Sep 28;23(36):6733-6740
pubmed: 29085218
BMC Anesthesiol. 2020 Aug 19;20(1):207
pubmed: 32814546
J Eval Clin Pract. 2020 Jun;26(3):992-1000
pubmed: 31407484
Eur J Anaesthesiol. 2002 Nov;19(11):780-8
pubmed: 12442926
Transplant Proc. 2015 May;47(4):1204-6
pubmed: 26036554
Lancet. 1999 Jun 12;353(9169):2051-8
pubmed: 10376632
Transplant Proc. 2016 May;48(4):1074-6
pubmed: 27320560
J Clin Anesth. 2017 Feb;37:103-107
pubmed: 28235493
Ann Surg. 2018 Aug;268(2):233-240
pubmed: 29300708
Reg Anesth Pain Med. 2016 Jul-Aug;41(4):460-8
pubmed: 27281726
BMC Anesthesiol. 2018 Apr 10;18(1):36
pubmed: 29631564
Surg Clin North Am. 2004 Apr;84(2):401-11
pubmed: 15062652
Am J Surg. 2018 Jan;215(1):138-143
pubmed: 28958651
Front Pharmacol. 2018 Jan 04;8:940
pubmed: 29354054
J Int Med Res. 2018 Sep;46(9):3563-3569
pubmed: 30032679
Pain Pract. 2018 Sep;18(7):925-945
pubmed: 29393998
Reg Anesth Pain Med. 2021 May;46(5):433-445
pubmed: 33436442
Clin J Pain. 2014 Jul;30(7):571-6
pubmed: 24281275
Ann Surg. 2019 Aug;270(2):209-210
pubmed: 31188224
J Gastrointest Oncol. 2012 Mar;3(1):41-7
pubmed: 22811868
Br J Surg. 2015 Dec;102(13):1619-28
pubmed: 26447461
Br J Pain. 2015 May;9(2):78-85
pubmed: 26516562
Clin Transplant. 2017 Apr;31(4):
pubmed: 28199752
Ann Surg. 2019 Mar;269(3):413-419
pubmed: 30080727
Reg Anesth Pain Med. 2014 Nov-Dec;39(6):506-12
pubmed: 25304475