CLINICAL EVALUATION OF OPIOID-SPARING PAIN MANAGEMENT PROTOCOLS FOLLOWING MAJOR ABDOMINAL SURGERY

Abstract

The abdominal pain experienced after the surgery, especially in big surgeries has been managed by administration of opioids, which have led to morbidity, opioid-dependency and poor healing. There have been proposals of multi-modes, opioid-sparing approaches to anaesthesia but the question arises, which mode is most helpful.We carried out a systematic review and meta-analysis comparing safety and effectiveness of the opioid-sparing mechanisms of managing the abdominal postoperative pain to the traditional opioid-based mechanisms of managing the abdominal postoperative pain in adult patients. We have located 45 randomized studies (38 of these will be included in meta-analysis) that compared opioid-sparing and opioid-based techniques in MEDLINE, Embase, Cochrane CENTRAL and Web of Science. The main outcomes of interest will be the overall use of opioids (milligram equivalents of intravenous morphine) and pain 24 and 48 hrs postoperative. The secondary outcomes are the opioid-related side effects, time to discharge, recovery and patient-reported outcomes. Random-effects meta-analyses, subgroup, meta-regression and sensitivity analyses were done.The opioid-free protocols had large effects compared to the multimodal protocols, in terms of opioid consumption at 24 hours (standardised mean difference: -1.82; 95 percent confidence interval: -2.09 to The number needed to treat and the adverse events associated with using opioids were also half-way (risk ratio: 0.48; 95 Even The meta The major results were not influenced by the high risk of bias studies and publication bias.The outcomes of opioid-sparing pain management (i.e., opioid-free anesthesia and regional anesthetic techniques) are a decrease in opioid use, pain management, a reduction of opioid side effects, reduction in length of stay and enhanced recovery among major abdominal surgery patients. The multimodal and opioid-free strategies, in our view, need to be provided as part of the improved perioperative recovery and implementation requirements and surgical education to allow them to address the pain in the 21 st century.