Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims Background Patients with pre-existing chronic pain or those on high-dose opioid medications while presenting for surgery may be at increased risk of severe post-surgical pain and associated complications. However, findings from existing scientific literature that explore the role of adjunctive therapies to minimise postoperative pain or perioperative opioid use have been discordant. This review aimed to identify and evaluate the effectiveness of opioid-sparing interventions on post-surgical pain in patients with pre-existing chronic pain or high-dose opioid use.
Methods The databases PubMed, EMBASE, CINAHL Plus, Web of Science Core Collection and PsychINFO were searched for contemporary studies meeting pre- specified inclusion criteria. Methodological rigour was assessed, and data was extracted using bespoke forms. The last search was conducted on January 29, 2023.
Results Sixteen studies were eligible for inclusion. Eight studies were suitable for meta-analysis to explore perioperative ketamine administration. We identified a tendency towards improvement in early postoperative pain scores (-0.27 [-0.79, 0.26]) and opioid use (-0.27 [-0.55, 0.00] SMD); however, this did not achieve statistical significance. Celecoxib improved pain scores in THA and TKA patients p=0.024 and pregabalin reduced opioid consumption by 64.78% p<0.001; however, periarticular liposomal bupivacaine did not show benefit.
Conclusions We identified some improvement in postoperative pain scores and reduction in analgesic requirements with the use of ketamine, pregabalin and celecoxib individually as anaesthetic adjuncts in targeted surgical populations. The heterogeneity of study endpoints and the risk of bias limit the ability to make definitive conclusions. More research, in potentially higher risk-of-pain populations, using internationally agreed definitions, would be helpful.