Intraoperative pharmacologic opioid minimisation strategies and patient-centred outcomes after surgery: a scoping review.

adult anaesthesia clinical pharmacology opioid minimisation strategies pain management patient-centred outcomes

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
07 Feb 2024
Historique:
received: 13 10 2023
revised: 08 12 2023
accepted: 02 01 2024
medline: 9 2 2024
pubmed: 9 2 2024
entrez: 8 2 2024
Statut: aheadofprint

Résumé

Postoperative patient-centred outcome measures are essential to capture the patient's experience after surgery. Although a large number of pharmacologic opioid minimisation strategies (i.e. opioid alternatives) are used for patients undergoing surgery, it remains unclear which strategies are most promising in terms of patient-centred outcome improvements. This scoping review had two main objectives: (1) to map and describe evidence from clinical trials assessing the patient-centred effectiveness of pharmacologic intraoperative opioid minimisation strategies in adult surgical patients, and (2) to identify promising pharmacologic opioid minimisation strategies. We searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases from inception to February 2023. We included trials investigating the use of opioid minimisation strategies in adult surgical patients and reporting at least one patient-centred outcome. Study screening and data extraction were conducted independently by at least two reviewers. Of 24,842 citations screened for eligibility, 2803 trials assessed the effectiveness of intraoperative opioid minimisation strategies. Of these, 457 trials (67,060 participants) met eligibility criteria, reporting at least one patient-centred outcome. In the 107 trials that included a patient-centred primary outcome, patient wellbeing was the most frequently used domain (55 trials). Based on aggregate findings, dexmedetomidine, systemic lidocaine, and COX-2 inhibitors were promising strategies, while paracetamol, ketamine, and gabapentinoids were less promising. Almost half of the trials (253 trials) did not report a protocol or registration number. Researchers should prioritise and include patient-centred outcomes in the assessment of opioid minimisation strategy effectiveness. We identified three potentially promising pharmacologic intraoperative opioid minimisation strategies that should be further assessed through systematic reviews and multicentre trials. Findings from our scoping review may be influenced by selective outcome reporting bias. OSF - https://osf.io/7kea3.

Sections du résumé

BACKGROUND BACKGROUND
Postoperative patient-centred outcome measures are essential to capture the patient's experience after surgery. Although a large number of pharmacologic opioid minimisation strategies (i.e. opioid alternatives) are used for patients undergoing surgery, it remains unclear which strategies are most promising in terms of patient-centred outcome improvements. This scoping review had two main objectives: (1) to map and describe evidence from clinical trials assessing the patient-centred effectiveness of pharmacologic intraoperative opioid minimisation strategies in adult surgical patients, and (2) to identify promising pharmacologic opioid minimisation strategies.
METHODS METHODS
We searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases from inception to February 2023. We included trials investigating the use of opioid minimisation strategies in adult surgical patients and reporting at least one patient-centred outcome. Study screening and data extraction were conducted independently by at least two reviewers.
RESULTS RESULTS
Of 24,842 citations screened for eligibility, 2803 trials assessed the effectiveness of intraoperative opioid minimisation strategies. Of these, 457 trials (67,060 participants) met eligibility criteria, reporting at least one patient-centred outcome. In the 107 trials that included a patient-centred primary outcome, patient wellbeing was the most frequently used domain (55 trials). Based on aggregate findings, dexmedetomidine, systemic lidocaine, and COX-2 inhibitors were promising strategies, while paracetamol, ketamine, and gabapentinoids were less promising. Almost half of the trials (253 trials) did not report a protocol or registration number.
CONCLUSIONS CONCLUSIONS
Researchers should prioritise and include patient-centred outcomes in the assessment of opioid minimisation strategy effectiveness. We identified three potentially promising pharmacologic intraoperative opioid minimisation strategies that should be further assessed through systematic reviews and multicentre trials. Findings from our scoping review may be influenced by selective outcome reporting bias.
STUDY REGISTRATION BACKGROUND
OSF - https://osf.io/7kea3.

Identifiants

DOI: 10.1016/j.bja.2024.01.006 PMID: 38331658
pubmed: 38331658
pii: S0007-0912(24)00009-6
doi: 10.1016/j.bja.2024.01.006
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Auteurs

Michael Verret (M)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Civic Campus, The Ottawa Hospital, Ottawa, ON, Canada; Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada. Electronic address: mverr051@uottawa.ca.

Nhat H Lam (NH)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Manoj Lalu (M)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Civic Campus, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Stuart G Nicholls (SG)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Alexis F Turgeon (AF)

Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada; Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec City, QC, Canada.

Daniel I McIsaac (DI)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Civic Campus, The Ottawa Hospital, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Myriam Hamtiaux (M)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

John Bao Phuc Le (J)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Ian Gilron (I)

Department of Anesthesiology & Perioperative Medicine, Biomedical & Molecular Sciences, Centre for Neuroscience Studies and School of Policy Studies, Queen's University, Kingston, ON, Canada.

Lucy Yang (L)

Faculty of Medicine, University of Calgary, Calgary, AB, Canada.

Mahrukh Kaimkhani (M)

Faculty of Medicine, University of Calgary, Calgary, AB, Canada.

Alexandre Assi (A)

School of Medicine, Trinity College Dublin, Dublin, Ireland.

David El-Adem (D)

Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.

Makenna Timm (M)

Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Peter Tai (P)

Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.

Joelle Amir (J)

Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.

Sriyathavan Srichandramohan (S)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Abdulaziz Al-Mazidi (A)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Nicholas A Fergusson (NA)

Department of Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, Canada.

Brian Hutton (B)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.

Fiona Zivkovic (F)

Patient partner, The Ottawa Hospital, Ottawa, ON, Canada.

Megan Graham (M)

Patient partner, The Ottawa Hospital, Ottawa, ON, Canada.

Maxime Lê (M)

Patient partner, The Ottawa Hospital, Ottawa, ON, Canada.

Allison Geist (A)

Patient partner, The Ottawa Hospital, Ottawa, ON, Canada.

Mélanie Bérubé (M)

Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec City, QC, Canada; Faculty of Nursing, Université Laval, Québec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada.

Patricia Poulin (P)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.

Risa Shorr (R)

Library Services, The Ottawa Hospital, Ottawa, ON, Canada.

Helena Daudt (H)

Pain Canada, Pain BC, Vancouver, BC, Canada.

Guillaume Martel (G)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.

Jason McVicar (J)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Civic Campus, The Ottawa Hospital, Ottawa, ON, Canada.

Husein Moloo (H)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.

Dean A Fergusson (DA)

Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.

Classifications MeSH