Intraoperative Methadone Use in Cardiac Surgery: A Systematic Review

Pain Medicine ◽  
2021 ◽  
Author(s):  
Veronika A Lobova ◽  
John M Roll ◽  
Marshall L C Roll
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Quality Assessment ◽  
Standard Of Care ◽  
Risk Of Bias ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Acute Postoperative Pain ◽  
Manual Search

Abstract Objective To investigate the effects of intraoperative methadone to standard of care opioids such as fentanyl and morphine on pain scores, opioid consumption, and adverse effects in adults undergoing cardiothoracic surgery. Methods The literature was reviewed on PubMed, Embase, Cochrane Library, and Google Scholar, followed by a manual search using reference lists of the identified articles. Search terms included a combination of intraoperative methadone, methadone, and cardiac surgery. Our review includes four studies published between 2011 and 2020. Quality assessment of the studies was performed. Results The initial search identified 715 articles with 461 duplicates removed, and 236 eliminated based on inclusion and exclusion criteria. Eighteen articles underwent full-text review. Four studies evaluating a total of 435 patients with various cardiothoracic procedures were included in this review. We found that intraoperative methadone decreases acute postoperative pain and reduces postoperative opioid consumption in the first 24 postoperative hours in patients who received 0.1-0.3 mg/kg intraoperative methadone in comparison to morphine and fentanyl. No difference was found in adverse effects between the groups. Quality assessment of the studies showed a low risk of bias in three of the randomized controlled trials and a high risk of bias in the retrospective review because of the baseline confounding bias in the study design. Conclusions Intraoperative methadone use reduces acute postoperative pain and lowers opioid consumption in comparison to morphine and fentanyl. Initial results suggest that methadone may be an equivalent opioid to be administered during cardiothoracic procedures to reduce acute post-surgical pain, though further research is warranted.

scholarly journals Intra-articular magnesium to alleviate postoperative pain after arthroscopic knee surgery: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lijun Shi ◽  
Haiyun Zhu ◽  
Jinhui Ma ◽  
Li-Li Shi ◽  
Fuqiang Gao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Pain Intensity ◽  
Opioid Consumption ◽  
Knee Surgery ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Arthroscopic Knee Surgery ◽  
Randomized Controlled ◽  
Arthroscopic Knee

Abstract Objective We aimed to evaluate the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 h after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results In total, 11 studies involving 677 participants met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions Intra-articular magnesium is an effective and safe coadjuvant treatment for relieving postoperative pain intensity after arthroscopic knee surgery. Protocol registration at PROSPERO: CRD42020156403.

scholarly journals Intraoperative Methadone Reduces Pain and Opioid Consumption in Acute Postoperative Pain

2019 ◽  
Vol 129 (6) ◽  
pp. 1723-1732 ◽  
Author(s):  
Felipe C. Machado ◽  
Joaquim E. Vieira ◽  
Flávia A. de Orange ◽  
Hazem A. Ashmawi
Keyword(s):  
Postoperative Pain ◽  
Opioid Consumption ◽  
Acute Postoperative Pain

scholarly journals The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Mark C. Kendall ◽  
Lucas J. Alves ◽  
Kristi Pence ◽  
Taif Mukhdomi ◽  
Daniel Croxford ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Postanesthesia Care Unit ◽  
Controlled Trials ◽  
Randomized Controlled

Background and Objectives. Methadone is commonly used in chronic pain, but it is not frequently used as an intraoperative analgesic. Several randomized studies have compared intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. The aim of this investigation was to compare the analgesic efficacy of intraoperative methadone to morphine in patients undergoing surgical procedures. Methods. We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration’s tool. Results. Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P<0.001. Conclusions. The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.

scholarly journals Effect of Preemptive Acetaminophen on Opioid Consumption: A Meta-Analysis

2021 ◽  
pp. E153-E160
Keyword(s):  
General Anesthesia ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Potential Method ◽  
Included Study ◽  
Risk Of Bias ◽  
Opioid Consumption ◽  
Preemptive Analgesia ◽  
Cochrane Library ◽  
Pain Scores

BACKGROUND: Strategies for reducing postoperative opioid consumption have been explored in many recent studies, due in large part to the recent opioid epidemic. Preemptive analgesia has been proposed as a potential method, but its use is still controversial. OBJECTIVES: This review aimed to evaluate the efficacy of a single dose of acetaminophen as preemptive analgesia for patients undergoing general anesthesia. STUDY DESIGN: A meta-analysis of randomized controlled trials (RCTs). SETTING: The electronic databases of PubMed, EMBASE, Cochrane Library, and the Web of Science were searched. The protocol was previously registered in the PROSPERO database under the registration number CRD 42020165634. METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RCTs that compared preemptive acetaminophen with placebo in surgical patients receiving general anesthesia were included. The risk of bias for each included study was independently assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Six studies with 563 patients were included. Overall, the studies showed a reduction in 24-hour opioid consumption (standardized mean difference [SMD], –1.45; 95% confidence interval [CI], –2.36 to –0.55; P = 0.002), pain scores at 12 hours postoperatively (SMD, –0.86; 95% CI, –1.25 to –0.48; P < 0.0001), and a lower incidence of postoperative nausea (risk ratio [RR] 0.45; 95% CI, 0.34–0.58; P < 0.001) and vomiting (RR 0.39; 95% CI, 0.22–0.72; P = 0.002). LIMITATIONS: The major limitation of this meta-analysis relates to the risk of bias in the limited number of included studies. CONCLUSIONS: Preemptive acetaminophen administration significantly reduces opioid consumption within the initial 24 hours following general anesthesia, with lower pain scores at 12 hours after surgery, and less nausea and vomiting. However, well-conducted RCTs are still needed. KEY WORDS: Acetaminophen, preemptive analgesia, perioperative pain management, postoperative opioid consumption, opioid-related side effects

scholarly journals Efficacy of Preemptive Analgesia with Pregabalin in Orthognathic Surgery-A Systematic Review

2021 ◽  
pp. 334-340
Author(s):  
Subhashini Ramasubbu ◽  
Abdul Wahab
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Central Sensitization ◽  
Orthognathic Surgery ◽  
Pain Treatment ◽  
Oral Surgery ◽  
Preemptive Analgesia ◽  
Surgical Trauma ◽  
Acute Postoperative Pain ◽  
Manual Search

Background: Orthognathic surgery is a treatment approach that is used for correcting the congenital or developmental anomalies of maxilla and mandible as well as secondary deformities of trauma. During these procedure saws, chisels, separators, and plate screw systems are used. Postoperative pain is an acute pain that is accompanied by the inflammatory process that occurs as a result of surgical trauma, and gradually decreases with tissue recovery. The analgesic prevents the establishment of the central sensitization due to incisional injury (only covers the surgical period) and prevents the establishment of the central sensitization (covering the surgical and early postoperative periods). Pregabalin is a structural gama-aminobutyric acid (GABA) analogue. It has been shown in recent studies that pregabalin, which is involved in chronical pain treatment, can also be involved in acute postoperative pain treatment. Objectives: The aim of this systematic review is to assess the efficacy of preemptive analgesia with pregabalin on postoperative pain in orthognathic surgery. Materials and Methods: The Data Bases of PubMed, Cochrane and Google scholar were searched for the related topics along with a complimentary manual search of all oral surgery journals till September 2019. Articles were selected based on the inclusion criteria, which included all RCTs. Results: From this systematic review it is concluded that pre-emptive analgesia with pregabalin is effective in lowering acute postoperative pain in the patients who have undergone orthognathic surgery. Conclusion: In this systematic review we have concluded that, on average, a single dose of pregabalin was shown to decrease post-operative pain. More studies have to be done to evaluate the efficacy of the drug.   

scholarly journals Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis

2020 ◽  
Vol 15 (2) ◽  
pp. 157-166
Author(s):  
Ji Youn Ju ◽  
Kye-Min Kim ◽  
Sangseok Lee
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Collaboration ◽  
Systemic Administration ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Preoperative Administration

Background: Alpha-2 agonists have sedative, analgesic, and opioid-sparing effects. Moreover, intraoperative or postoperative systemic administration of alpha-2 adrenergic agonists is known to reduce postoperative pain and opioid consumption. This meta-analysis investigated whether preoperative administration of alpha-2 agonists can affect postoperative pain and opioid consumption.Methods: We searched the MEDLINE, EMBASE, Cochrane Library (CENTRAL), KoreaMed, and KMbase databases through March 2019 to identify relevant randomized controlled trials (RCTs) on the effect of preoperative systemic administration of alpha-2 agonists on postoperative pain and opioid consumption. We conducted a meta-analysis according to the Cochrane Collaboration guidelines. Standardized mean differences (SMDs) of postoperative pain intensity or dose of opioid consumption in the alpha-2 agonist group were extracted and combined using a random-effect model and were compared to those of the control group.Results: Eleven RCTs involving 748 participants were included in this meta-analysis. Preoperative administration of systemic alpha-2 agonists significantly reduced cumulative opioid consumption up to 6 h (SMD, –0.52; 95% confidence interval [–0.90 to –0.14]) and 24 h (SMD, –0.68 [–1.27 to –0.09]) after surgery. Moreover, preoperative administration of alpha-2 agonists significantly reduced postoperative pain intensity at 6 h (SMD, –0.50 [–0.78 to –0.21]) and 24 h (SMD, –0.44 [–0.86 to –0.03]).Conclusions: In this meta-analysis, high degree of heterogeneity limits the preoperative administration of alpha-2 agonists in reducing postoperative opioid consumption and pain intensity. Future powered large RCTs are required to increase the certainty of evidence on the effect in reducing postoperative opioid consumption and pain intensity.

scholarly journals Intracanal Cryotherapy and its Effects on the Postoperative Pain in Root Canal Therapy: Systematic Review & Meta-analysis Protocol.

2020 ◽  
Author(s):  
Durre Sadaf ◽  
Muhammad Zubair Ahmad ◽  
Igho Onakpoya
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Root Canal ◽  
Search Strategy ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Root Canal Therapy ◽  
Bias Assessment ◽  
Comprehensive Search ◽  
Comprehensive Search Strategy

Abstract Background: There are many research studies directing in lowering postoperative pain in root canal therapy. The use of intracanal cryotherapy in root canal treatment is recently introduced, and many researchers are inclined towards this techniques. This systematic review will give an insight into its application in endodontic therapy and its effects on postoperative pain.The aim of this systematic review is to evaluate the effect of intracanal cryotherapy on the postoperative pain in patients with pulp diseases and with or without peri-radicular infection during root canal therapy. This systematic review will include randomized controlled trials only. The studies should encompass patients with pulpal diseases, i.e. irreversible pulpitis and pulp necrosis in teeth. Previously root treated teeth, immature, and teeth with root resorption will not be included. Methods: We will conduct a comprehensive search strategy using electronic databases PubMed, EMBASE (Ovid), Scopus, and Cochrane library. A predefined inclusion and exclusion criteria will be utilized for the selection of studies. The reference list of selected studies will be manually searched. We will extract data from studies on a structured data collection form. At the same time, the risk of bias assessment of studies using the Cochrane risk of bias assessment tools will be performed by two reviewers independently. Furthermore, qualitative and quantitative data synthesis will be accomplished. The data will be presented in the form of table of summary of findings. Discussion: This systematic review will assess the role of intracanal cryotherapy in the form of cold saline irrigation as a final irrigant during root canal therapy. The quality of evidence will ranked as high, moderate low or very low using GRADE approach. Comprehensive search strategy, risk of bias assessment using Cochrane risk of bias assessment tool by two reviewers are the strength of this systematic review. Systematic review registration number: The protocol is registered with the International Prospective Register of Systematic Reviews. (PROSPERO CRD 42020163438)

scholarly journals Intravenous patient-controlled analgesia plus psychoeducational intervention for acute postoperative pain in patients with pulmonary nodules after thoracoscopic surgery: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sha Li ◽  
Xian Ding ◽  
Yong Zhao ◽  
Xiao Chen ◽  
Jianfeng Huang
Keyword(s):  
Postoperative Pain ◽  
Thoracoscopic Surgery ◽  
Opioid Consumption ◽  
Psychoeducational Intervention ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Opioid Medications ◽  
The Impact

Abstract Background The association of psychological factors with postoperative pain has been well documented. The incorporation of psychoeducational intervention into a standard analgesia protocol seems to be an attractive approach for the management of acute postoperative pain. Our study aimed to evaluate the impact of psychoeducational intervention on acute postoperative pain in pulmonary nodule (PN) patients treated with thoracoscopic surgery. Methods In this study, 76 PN patients treated with thoracoscopic surgery and intravenous patient-controlled analgesia (IV-PCA) plus psychoeducational evaluation and intervention were selected as the psychoeducational intervention group (PG). Another 76 PN patients receiving IV-PCA without psychoeducational intervention after thoracoscopic surgery, treated as the control group (CG), were identified from the hospital database and matched pairwise with PG patients according to age, sex, preoperative body mass index (BMI), opioid medications used for IV-PCA and the educational attainment of patients. Results The most common psychological disorders were anxiety and interpersonal sensitivity, which were recorded from 82.9% (63/76) and 63.2% (48/76) of PG patients. The numerical rating scale (NRS) pain scores of the PG patients were significantly lower than those of the CG patients at 2 and 24 h after surgery (P < 0.001). Total opioid consumption for acute postoperative pain in the PG was 52.1 mg of morphine equivalent, which was significantly lower than that (67.8 mg) in the CG (P = 0.038). PG patients had a significantly lower incidence of rescue analgesia than CG patients (28.9% vs. 44.7%, P = 0.044). Nausea/vomiting was the most common side effect of opioid medications, recorded for 3 (3.9%) PG patients and 10 (13.2%) CG patients (P = 0.042). In addition, no significant difference was observed between PG and CG patients in terms of grade 2 or higher postoperative complications (10.5% vs. 17.1%, P = 0.240). Conclusions Psychoeducational intervention for PN patients treated with thoracoscopic surgery resulted in reduced acute postoperative pain, less opioid consumption and fewer opioid-related side effects.

Sign in / Sign up

Export Citation Format

Share Document