Non-opioid analgesics for the prevention of chronic postsurgical pain: a systematic review and network meta-analysis.

Abstract

BACKGROUND:

Chronic postsurgical pain is common after surgery. Identification of non-opioid analgesics with potential for preventing chronic postsurgical pain is important, although trials are often underpowered. Network meta-analysis offers an opportunity to improve power and to identify the most promising therapy for clinical use and future studies.

METHODS:

We conducted a PRISMA-NMA-compliant systematic review and network meta-analysis of randomised controlled trials of non-opioid analgesics for chronic postsurgical pain. Outcomes included incidence and severity of chronic postsurgical pain, serious adverse events, and chronic opioid use.

RESULTS:

We included 132 randomised controlled trials with 23 902 participants. In order of efficacy, i.v. lidocaine (odds ratio [OR] 0.32; 95% credible interval [CrI] 0.17-0.58), ketamine (OR 0.64; 95% CrI 0.44-0.92), gabapentinoids (OR 0.67; 95% CrI 0.47-0.92), and possibly dexmedetomidine (OR 0.36; 95% CrI 0.12-1.00) reduced the incidence of chronic postsurgical pain at ≤6 months. There was little available evidence for chronic postsurgical pain at >6 months, combinations agents, chronic opioid use, and serious adverse events. Variable baseline risk was identified as a potential violation to the network meta-analysis transitivity assumption, so results are reported from a fixed value of this, with analgesics more effective at higher baseline risk. The confidence in these findings was low because of problems with risk of bias and imprecision.

CONCLUSIONS:

Lidocaine (most effective), ketamine, and gabapentinoids could be effective in reducing chronic postsurgical pain ≤6 months although confidence is low. Moreover, variable baseline risk might violate transitivity in network meta-analysis of analgesics; this recommends use of our methods in future network meta-analyses.

SYSTEMATIC REVIEW PROTOCOL:

PROSPERO CRD42021269642.

• Authors: Brett Doleman, Ole Mathiesen, Alex J Sutton, Nicola J Cooper, Jon N Lund, John P Williams
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 130 Issue 6 Pg. 719-728 (06 2023) ISSN: 1471-6771 [Electronic] England
• PMID: 37059625 (Publication Type: Meta-Analysis, Systematic Review, Journal Article, Review)
• Copyright: Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Analgesics, Non-Narcotic
• Ketamine
• Analgesics
• Lidocaine
• Analgesics, Opioid

Topics

• Humans
• Analgesics, Non-Narcotic (therapeutic use)
• Network Meta-Analysis
• Ketamine (therapeutic use)
• Analgesics (therapeutic use)
• Pain, Postoperative (drug therapy, prevention & control)
• Lidocaine (therapeutic use)
• Analgesics, Opioid (adverse effects)