Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis.

Details

Serval ID
serval:BIB_6587D8A257C3
Type
Article: article from journal or magazin.
Collection
Publications
Title
Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis.
Journal
Anaesthesia
Author(s)
Frauenknecht J., Kirkham K.R., Jacot-Guillarmod A., Albrecht E.
ISSN
1365-2044 (Electronic)
ISSN-L
0003-2409
Publication state
Published
Issued date
05/2019
Peer-reviewed
Oui
Volume
74
Number
5
Pages
651-662
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis ; Systematic Review
Publication Status: ppublish
Abstract
Opioids are administered peri-operatively for postoperative analgesia, and intra-operatively to control the sympathetic response to surgical stimuli, frequently as a surrogate for presumed pain. However, opioid use during surgery is a matter of dispute in contemporary practice and carries the risk of side-effects such as postoperative nausea and vomiting. This meta-analysis investigated whether opioid-inclusive, compared with opioid-free anaesthesia, would reduce postoperative pain, without increasing the rate of postoperative nausea and vomiting. The electronic databases Medline and PubMed were searched until June 2018. We included trials investigating pain outcomes and comparing any type of intra-operative opioid administration with placebo injection or no intra-operative opioid. Most meta-analyses were performed using a random effects model. We rated the quality of evidence for each outcome. The primary outcome was pain score at rest (analogue scale, 0-10) at two postoperative hours. Our secondary outcomes included the rate of postoperative nausea and vomiting within the first 24 postoperative hours and length of stay in the recovery area. Twenty-three randomised controlled trials, including 1304 patients, were identified. Pain scores at rest at two postoperative hours were equivalent in the opioid-inclusive and opioid-free groups with a mean difference (95%CI) of 0.2 (-0.2 to 0.5), I <sup>2</sup> = 83%, p = 0.38 and a high quality of evidence. Similarly, there was high-quality evidence that the rate of postoperative nausea and vomiting was reduced in the opioid-free group, with a risk ratio (95%CI) of 0.77 (0.61-0.97), I <sup>2</sup> = 16%, p = 0.03 and high-quality evidence for a similar length of stay in the recovery area, the mean difference (95%CI) being 0.6 (-8.2 to 9.3), min, I <sup>2</sup> = 60%, p = 0.90. As there is strong evidence that opioid-inclusive anaesthesia does not reduce postoperative pain, but is associated with more postoperative nausea and vomiting, when compared with opioid-free anaesthesia, we suggest that anaesthetists should reconsider their intra-operative opioid choices on a case-by-case basis.
Keywords
Analgesics, Opioid/administration & dosage, Analgesics, Opioid/adverse effects, Anesthesia, General/methods, Drug Administration Schedule, Humans, Intraoperative Care/methods, Pain, Postoperative/prevention & control, Postoperative Nausea and Vomiting/chemically induced, analgesia, hyperalgesia, opioid, postoperative pain
Pubmed
Web of science
Open Access
Yes
Create date
31/03/2019 16:32
Last modification date
15/10/2019 14:25
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