Efficacy and safety of sufentanil sublingual tablet system in postoperative pain management: a systematic review and meta-analysis

BackgroundSufentanil sublingual tablet system (SSTS) is a recently approved formulation for postoperative pain management that has become popular due to its pharmacokinetic properties such as good bioavailability, rapid attainment of equilibrium and elimination without any metabolites, along with its pharmacodynamic properties such as rapid onset and effective pain reduction. It is also relatively well tolerated by patients.ObjectiveThis is a quantitative analysis of the efficacy and safety of SSTS in patients with moderate to severe postoperative pain.DesignThis is a systematic review and meta-analysis. Databases such as Cochrane Library, MEDLINE and EMBASE were searched for eligible articles.SettingsRandomised controlled trials published after 2000 in English language and which assessed at least one of the outcome measures of interest with pain intensity difference between 12 hours and a maximum of 96 hours.ParticipantsAdults with moderate to severe postoperative pain and taking SSTS for pain management.MethodsData were analysed using Review Manager (RevMan) V.5.3. Risk of bias (RoB) assessment was done using RoB-2 scale, and overall grading of evidence of each outcome was done using GRADEpro Guideline Development Tool.ResultsAnalysis of SSTS versus control indicates a statistically significant reduction in summed pain intensity difference at 12 hours (mean difference (MD)=−12.33 (95% CI −15.5 to −9.17), p<0.00001), summed pain intensity difference at 48 hours (MD=−43.57 (95% CI −58.65 to −28.48), p<0.00001), time-weighted total pain relief over 12 hours (MD=−4.77 (95% CI −6.28 to −3.27), p<0.00001) and pain intensity difference (MD=–0.73 (95% CI −1.00 to −0.46), p<0.00001) with SSTS, alongside high quality of evidence. Success of treatment as assessed by Patient Global Assessment (OR=4.01 (95% CI 2.74 to 5.89), p<0.00001) and Healthcare Professional Global Assessment (OR=4.46 (95% CI 3.03 to 6.56), p<0.00001) scoring at 72 hours was observed in a significantly high number of individuals using SSTS, with high quality of evidence. There was no difference in adverse events except for dizziness (RR=1.90, 95% CI 1.02 to 3.52). There was a significantly higher number of total adverse events in orthopaedic surgery in the SSTS group than in the comparator.ConclusionSSTS is effective in postoperative pain management in patients with moderate to severe pain. It also has good tolerability and high patient satisfaction.PROSPERO registration numberCRD42018115458.

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Pain management after lung surgery

Nursing Reports ◽

10.4081/nursrep.2014.3225 ◽

2014 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Maria Frödin ◽

Margareta Warrén Stomberg

Keyword(s):

Quality Of Care ◽

Pain Management ◽

Postoperative Pain ◽

Severe Pain ◽

Postoperative Pain Management ◽

Lung Surgery ◽

Moderate Pain ◽

Number Of Patients ◽

Severe Postoperative Pain

Pain management is an integral challenge in nursing and includes the responsibility of managing patients’ pain, evaluating pain therapy and ensuring the quality of care. The aims of this study were to explore patients’ experiences of pain after lung surgery and evaluate their satisfaction with the postoperative pain management. A descriptive design was used which studied 51 participants undergoing lung surgery. The incidence of moderate postoperative pain varied from 36- 58% among the participants and severe pain from 11-26%, during their hospital stay. Thirty-nine percent had more pain than expected. After three months, 20% experienced moderate pain and 4% experienced severe pain, while after six months, 16% experienced moderate pain. The desired quality of care goal was not fully achieved. We conclude that a large number of patients experienced moderate and severe postoperative pain and more than one third had more pain than expected. However, 88% were satisfied with the pain management. The findings confirm the severity of pain experienced after lung surgery and facilitate the apparent need for the continued improvement of postoperative pain management following this procedure.

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Efficacy of non-opioid analgesics to control postoperative pain: a network meta-analysis

BMC Anesthesiology ◽

10.1186/s12871-020-01147-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

John A. Carter ◽

Libby K. Black ◽

Dolly Sharma ◽

Tarun Bhagnani ◽

Jonathan S. Jahr

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Human Subjects ◽

Meta Analysis ◽

Opioid Analgesics ◽

Abdominal Hysterectomy ◽

Orthopedic Procedures ◽

Intensity Difference ◽

Cumulative Probability ◽

Pain Intensity Difference

Abstract Background The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain. Methods We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000–2019, adult human subjects) of IV non-opioid analgesics (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in R to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 h postoperatively (sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish treatments on the basis of their outcomes such that higher SUCRA values indicate better outcomes. The study protocol was prospectively registered with by PROSPERO (CRD42019117360). Results Out of 2313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). MIV was associated with significantly less MME utilization versus all comparators for abdominal procedures, hysterectomy, and versus acetaminophen in orthopedic procedures. Elsewhere MME utilization outcomes for MIV were largely equivalent or nominally better than other comparators. Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory). Conclusions MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results as all comparisons involving MIV were indirect.

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Efficacy of non-opioid analgesics to control postoperative pain: A network meta-analysis

10.21203/rs.3.rs-29083/v2 ◽

2020 ◽

Author(s):

John A Carter ◽

Libby K Black ◽

Dolly Sharma ◽

Tarun Bhagnani ◽

Jonathan Jahr

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Human Subjects ◽

Meta Analysis ◽

Opioid Analgesics ◽

Abdominal Hysterectomy ◽

Orthopedic Procedures ◽

Intensity Difference ◽

Cumulative Probability ◽

Pain Intensity Difference

Abstract BACKGROUND The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain. METHODS We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000-2019, adult human subjects) of IV non-opioid analgesics (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in STATA (v15.0) to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 hours postoperatively (Sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish each treatment by efficacy and safety where higher SUCRA values indicated better outcomes. Treatments were also compared by frequency of opioid-related adverse events (ORADEs) including gastrointestinal and respiratory and reduction in morphine milligram equivalents (MME). The study protocol was prospectively registered with by PROSPERO (CRD42019117360). RESULTS Out of 2,313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). Significantly lower MME was associated with MIV for abdominal (vs acetaminophen, ibuprofen and ketorolac), bunionectomy (vs acetaminophen), hysterectomy (vs acetaminophen and ketorolac) and orthopedic procedures (vs acetaminophen and ibuprofen). Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory). CONCLUSIONS MIV 30mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results, as all comparisons involving MIV were indirect.

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Efficacy of non-opioid analgesics to control postoperative pain: A network meta-analysis

10.21203/rs.3.rs-29083/v1 ◽

2020 ◽

Author(s):

John A Carter ◽

Libby K Black ◽

Dolly Sharma ◽

Tarun Bhagnani ◽

Jonathan Jahr

Keyword(s):

Postoperative Pain ◽

Pain Intensity ◽

Human Subjects ◽

Meta Analysis ◽

Opioid Analgesics ◽

Abdominal Hysterectomy ◽

Orthopedic Procedures ◽

Intensity Difference ◽

Cumulative Probability ◽

Pain Intensity Difference

Abstract BACKGROUND The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain. METHODS We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000–2019, adult human subjects) of IV nonopioids (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in STATA (v13.0) to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 hours postoperatively (Sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish each treatment by efficacy and safety where higher SUCRA values indicated better outcomes. Treatments were also compared by frequency of opioid-related adverse events (ORADEs) including gastrointestinal and respiratory and reduction in morphine milligram equivalents (MME). The study protocol was prospectively registered with by PROSPERO (CRD42019117360). RESULTS Out of 2,313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). Significantly lower MME was associated with MIV for abdominal (vs acetaminophen, ibuprofen and ketorolac), bunionectomy (vs acetaminophen), hysterectomy (vs acetaminophen and ketorolac) and orthopedic procedures (vs acetaminophen and ibuprofen). Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory). CONCLUSIONS MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results, as all comparisons involving MIV were indirect.

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The quality of reporting of RCTs used within a postoperative pain management meta-analysis, using the CONSORT statement

BMC Anesthesiology ◽

10.1186/1471-2253-12-13 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 12

Author(s):

Victoria Borg Debono ◽

Shiyuan Zhang ◽

Chenglin Ye ◽

James Paul ◽

Aman Arya ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Meta Analysis ◽

Postoperative Pain Management ◽

Consort Statement ◽

Quality Of Reporting ◽

The Consort Statement

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Efficacy of tramadol for postoperative pain management in dogs: systematic review and meta-analysis

Veterinary Anaesthesia and Analgesia ◽

10.1016/j.vaa.2021.01.003 ◽

2021 ◽

Author(s):

Pablo A. Donati ◽

Lisa Tarragona ◽

Juan V.A. Franco ◽

Veronica Kreil ◽

Rodrigo Fravega ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Meta Analysis ◽

Postoperative Pain Management

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Postoperative pain management after esophagectomy: a systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/dox052 ◽

2017 ◽

Vol 30 (10) ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

E. Visser ◽

M. Marsman ◽

P. S. N. van Rossum ◽

E. Cheong ◽

K. Al-Naimi ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Meta Analysis ◽

Postoperative Pain Management

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The Quality Test for Postoperative Pain Management using the American Pain Society Patient Outcome Questionnaire Revisied (APS-POQ-R) version Indonesia at Mohammad Hoesin Hospital in Palembang (A study of the quality level of postoperative pain management

Jurnal RSMH Palembang ◽

10.37275/jrp.v1i2.6 ◽

2020 ◽

Vol 1 (2) ◽

pp. 41-45

Author(s):

Malina Resta Maria Panjaitan ◽

Dewi Arsinta ◽

Rose Mafiana

Keyword(s):

Patient Outcome ◽

Pain Management ◽

Postoperative Pain ◽

Emotional Experience ◽

Postoperative Pain Management ◽

Education Level ◽

Quality Level ◽

Outcome Questionnaire ◽

Post Operative Pain

A B S T R A C TPain is an unpleasant sensory and emotional experience associated with actual orpotential tissue damage, or described in terms of such damage. APS-POQ-R (RevisedAmerican Pain Society Patient Outcome Questionnaire) is a measuring tool for assessingthe quality of postoperative pain management by exploring patient experiences andoutcomes. This research aims to assess the quality of postoperative pain managementat Mohammad Hoesin Hospital Palembang and to determine the factors that influenceit. The Cross-sectional observational analytic study was conducted toward 51respondents. Data was collected primarily by using questionnares and interview. Datawas analyzed by using chi-square. The study showed that the quality of postoperativepain management at RSUP Mohammad Hoesin General Hospital Palembang has goodquality with a total of 27 patients (52.9%). From statistical analysis there wassignificant relationship between the quality of post-operative pain management withage (p=0,037), gender (p=0,027), ethnicity (p=0,039), education level (p=0,039), andeconomic level (p=0,005). So it can be concluded that was a significant relationshipbetween the quality of post-operative pain management with age, gender, ethnicity,education level, and economic level.

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