Efficacy of nonopioid analgesics and adjuvants in multimodal analgesia for reducing postoperative opioid consumption and complications in obesity: a systematic review and network meta-analysis

IF 9.1 1区医学 Q1 ANESTHESIOLOGY

British journal of anaesthesia Pub Date : 2024-10-03 DOI:10.1016/j.bja.2024.08.009

Michele Carron , Enrico Tamburini , Federico Linassi , Tommaso Pettenuzzo , Annalisa Boscolo , Paolo Navalesi

{"title":"Efficacy of nonopioid analgesics and adjuvants in multimodal analgesia for reducing postoperative opioid consumption and complications in obesity: a systematic review and network meta-analysis","authors":"Michele Carron , Enrico Tamburini , Federico Linassi , Tommaso Pettenuzzo , Annalisa Boscolo , Paolo Navalesi","doi":"10.1016/j.bja.2024.08.009","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity.</div></div><div><h3>Methods</h3><div>A systematic review and network meta-analysis was performed. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched. Only English-language RCTs investigating the use of nonopioid analgesics and adjuvants in adult surgical patients with obesity were included. The quality of evidence and certainty were assessed using the RoB 2 tool and GRADE framework, respectively.</div></div><div><h3>Results</h3><div>In total, 37 RCTs involving 3602 patients were included in the quantitative analysis. Compared with placebo/no intervention or a comparator, dexmedetomidine, ketamine, lidocaine, magnesium, and gabapentin significantly reduced postoperative opioid consumption after surgery. Ketamine/esketamine also significantly reduced POPCs. Ibuprofen, dexmedetomidine, and lidocaine significantly reduced postoperative nausea, whereas dexmedetomidine, either alone or combined with pregabalin, and lidocaine reduced postoperative vomiting. Dexmedetomidine significantly reduced PACU LOS, whereas both paracetamol and lidocaine reduced hospital LOS.</div></div><div><h3>Conclusions</h3><div>Intravenous nonopioid analgesics and adjuvants are crucial in multimodal anaesthesia, reducing opioid consumption and enhancing postoperative care in adult surgical patients with obesity.</div></div><div><h3>Systematic review protocol</h3><div>CRD42023399373 (PROSPERO).</div></div>","PeriodicalId":9250,"journal":{"name":"British journal of anaesthesia","volume":"133 6","pages":"Pages 1234-1249"},"PeriodicalIF":9.1000,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of anaesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0007091224004756","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity.

Methods

A systematic review and network meta-analysis was performed. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched. Only English-language RCTs investigating the use of nonopioid analgesics and adjuvants in adult surgical patients with obesity were included. The quality of evidence and certainty were assessed using the RoB 2 tool and GRADE framework, respectively.

Results

In total, 37 RCTs involving 3602 patients were included in the quantitative analysis. Compared with placebo/no intervention or a comparator, dexmedetomidine, ketamine, lidocaine, magnesium, and gabapentin significantly reduced postoperative opioid consumption after surgery. Ketamine/esketamine also significantly reduced POPCs. Ibuprofen, dexmedetomidine, and lidocaine significantly reduced postoperative nausea, whereas dexmedetomidine, either alone or combined with pregabalin, and lidocaine reduced postoperative vomiting. Dexmedetomidine significantly reduced PACU LOS, whereas both paracetamol and lidocaine reduced hospital LOS.

Conclusions

Intravenous nonopioid analgesics and adjuvants are crucial in multimodal anaesthesia, reducing opioid consumption and enhancing postoperative care in adult surgical patients with obesity.

Systematic review protocol

CRD42023399373 (PROSPERO).

查看原文本刊更多论文

多模式镇痛中的非阿片类镇痛剂和辅助剂对减少肥胖症术后阿片类药物用量和并发症的疗效：系统综述和网络荟萃分析。

背景：处理肥胖症患者的术后疼痛具有挑战性。尽管多模式镇痛已被证明能有效缓解疼痛，但不同的非阿片类静脉镇痛药和辅助药物对这些患者的具体影响尚未明确。本研究旨在评估非甾体类抗炎药、扑热息痛、氯胺酮、α-2 肾上腺素能受体激动剂、利多卡因、镁和口服加巴喷丁类药物在减少围手术期阿片类药物消耗方面的效果，以及在减轻肥胖症手术患者全身和术后肺部并发症（POPC）、恶心、呕吐、PACU 住院时间（LOS）和住院时间方面的效果：方法：进行了系统回顾和网络荟萃分析。检索了 PubMed、Scopus、Web of Science、CINAHL 和 EMBASE。仅纳入了研究肥胖症成人手术患者使用非阿片类镇痛药和辅助药物的英文 RCT。分别使用 RoB 2 工具和 GRADE 框架对证据质量和确定性进行评估：定量分析共纳入了 37 项 RCT，涉及 3602 名患者。与安慰剂/无干预或比较药相比，右美托咪定、氯胺酮、利多卡因、镁和加巴喷丁能显著减少术后阿片类药物的消耗。氯胺酮/开塞露也能显著减少持久性有机污染物。布洛芬、右美托咪定和利多卡因可明显减少术后恶心，而右美托咪定（单独使用或与普瑞巴林合用）和利多卡因可减少术后呕吐。右美托咪定明显缩短了 PACU 的住院时间，而扑热息痛和利多卡因都缩短了住院时间：结论：静脉注射非阿片类镇痛药和辅助药物在多模式麻醉中至关重要，可减少阿片类药物的用量并改善肥胖症成人手术患者的术后护理：CRD42023399373 (PROCROPERO)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.