Julio F Fiore1, Ghadeer Olleik2, Charbel El-Kefraoui3, Bernardo Verdolin2, Araz Kouyoumdjian4, Allison Alldrit5, Ana G Figueiredo2, Sofia Valanci2, Javier A Marquez-GdeV6, Matthew Schulz7, Dan Moldoveanu8, Philip Nguyen-Powanda9, Gordon Best7, Alexander Banks7, Tara Landry10, Nicolò Pecorelli3, Gabriele Baldini11, Liane S Feldman12. 1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada. Electronic address: julio.fiorejunior@mcgill.ca. 2. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada. 3. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. 4. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Faculty of Medicine, McGill University, Montreal, QC, Canada. 5. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Ingram School of Nursing, McGill University, Montreal, QC, Canada. 6. Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada. 7. Faculty of Medicine, McGill University, Montreal, QC, Canada. 8. Department of Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada. 9. Faculty of Sciences, McGill University, Montreal, QC, Canada. 10. Medical Libraries, McGill University Health Centre, Montreal, QC, Canada. 11. Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Canada McGill University, Montreal, QC, Canada. 12. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada; Department of Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Division of Experimental Surgery, McGill University, Canada McGill University, Montreal, QC, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Abstract
BACKGROUND: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. METHODS: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews. RESULTS: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia. CONCLUSIONS: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.
BACKGROUND: Excessive opioid prescribing after surgery has been recognised as a contributor to the current crisis of opioid addiction and overdose. Clinicians may potentially tackle this crisis by using opioid-free postoperative analgesia; however, the scientific literature addressing this approach is sparse and heterogeneous, thereby limiting robust conclusions. A scoping review was conducted to systematically map the extent, range, and nature of the literature addressing postoperative opioid-free analgesia. METHODS: Eight bibliographic databases were searched for studies addressing opioid-free analgesia after a major surgery. We extracted the study characteristics, including design, country, year, surgical procedure(s), and interventions. Results were organised thematically according to surgical specialty and targeted phase of recovery: in hospital (early recovery, ≤24 h after operation; intermediate recovery, >24 h) and post-discharge (late recovery). Reporting was according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for scoping reviews. RESULTS: We identified 424 studies addressing postoperative opioid-free analgesia. The number of studies conducted in countries where the opioid crisis is primarily focused was remarkably low (USA, n=11 [3%]; Canada, n=5 [1%]). Many RCTs compared opioid-free vs opioid analgesia during hospital stay (n=117), but few targeted analgesia post-discharge (n=8). Studies were predominantly focused on procedures in orthopaedic, general, and gynaecological/obstetric surgery. Limited attention has been directed towards non-pharmacological pain interventions. We did not identify knowledge synthesis studies (i.e. systematic reviews and meta-analyses) focused on the comparative effectiveness of opioid-free vs opioid analgesia. CONCLUSIONS: Opioids remain a mainstay analgesic for managing pain after surgery, but alternative analgesia strategies should not be overlooked. This scoping review indicates numerous opportunities for future research targeting opioid-free postoperative analgesia. REVIEW REGISTRATION: http://www.researchregistry.com; ID: reviewregistry576.
Authors: Uyen Do; Charbel El-Kefraoui; Makena Pook; Saba Balvardi; Natasha Barone; Philip Nguyen-Powanda; Lawrence Lee; Gabriele Baldini; Liane S Feldman; Julio F Fiore; Mohsen Alhashemi; Alen Antoun; Jeffrey S Barkun; Krista M Brecht; Prosanto K Chaudhury; Dan Deckelbaum; Elise Di Lena; Sinziana Dumitra; Hiba Elhaj; Paola Fata; David Fleiszer; Gerald M Fried; Jeremy Grushka; Pepa Kaneva; Kosar Khwaja; Maxime Lapointe-Gagner; Katherine M McKendy; Ari N Meguerditchian; Sarkis H Meterissian; Haley Montgomery; Fateme Rajabiyazdi; Nadia Safa; Nawar Touma; Francine Tremblay Journal: JAMA Netw Open Date: 2022-07-01
Authors: Elisabeth C McLemore; Lawrence Lee; Traci L Hedrick; Laila Rashidi; Erik P Askenasy; Daniel Popowich; Patricia Sylla Journal: Surg Endosc Date: 2022-09-21 Impact factor: 3.453