| Title: |
Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials |
| Authors: |
Carron, Michele; Tamburini, Enrico; Linassi, Federico; Pettenuzzo, Tommaso; Boscolo, Annalisa; Navalesi, Paolo |
| Contributors: |
Carron, Michele; Tamburini, Enrico; Linassi, Federico; Pettenuzzo, Tommaso; Boscolo, Annalisa; Navalesi, Paolo |
| Publication Year: |
2024 |
| Collection: |
Padua Research Archive (IRIS - Università degli Studi di Padova) |
| Subject Terms: |
analgesia; anesthesia; combined-modality therapy; complication; obesity; postoperative nausea and vomiting; postoperative pain; postoperative recovery; surgery; treatment outcome |
| Description: |
Background/Objectives: Managing postoperative pain in patients with obesity is challenging. Although using a combination of pain relief methods is recommended for these patients, the true effectiveness of various intravenous non-opioid analgesics and adjuvants in multimodal anesthesia needs to be better defined. Methods: A systematic review and network meta-analysis was performed to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ketamine, α-2 agonists, lidocaine, magnesium, and oral gabapentinoids in adult surgical patients with obesity. The analysis aimed to compare these treatments to a placebo/no treatment or alternative analgesics, with a primary focus on postoperative pain and secondary endpoints including rescue analgesia, postoperative nausea and vomiting (PONV), and recovery quality. English-language randomized controlled trials across PubMed, Scopus, Web of Science, CINAHL, and EMBASE were considered. Quality and evidence certainty were assessed with the RoB 2 tool and GRADE, and data was analyzed with R software. Results: NSAIDs, along with acetaminophen, lidocaine, α-2 agonists, ketamine, and oral gabapentinoids, effectively reduce early postoperative pain. NSAIDs, particularly ibuprofen, as well as acetaminophen, ketamine, and lidocaine, also show benefits in later postoperative stages. Intravenous non-opioid analgesics and adjuvants show some degree of benefit in reducing PONV and the need for rescue analgesic therapy when using α-2 agonists alone or combined with oral gabapentinoids, notably decreasing the likelihood of PONV. Ketamine, lidocaine, and α-2 agonists are shown to enhance postoperative recovery and care quality. Conclusions: Intravenous non-opioid analgesics and adjuvants are valuable in multimodal anesthesia for pain management in adult surgical patients suffering from obesity. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/38610865; info:eu-repo/semantics/altIdentifier/wos/WOS:001200938500001; volume:13; issue:7; journal:JOURNAL OF CLINICAL MEDICINE; https://hdl.handle.net/11577/3512289 |
| DOI: |
10.3390/jcm13072100 |
| Availability: |
https://hdl.handle.net/11577/3512289; https://doi.org/10.3390/jcm13072100 |
| Rights: |
info:eu-repo/semantics/openAccess ; license:Creative commons ; license uri:http://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.76362FF5 |
| Database: |
BASE |