ABSTRACT
Objectives
: To compare the relative efficacy of adjuvant non-opioid analgesic regimens in adult
cardiac surgical patients.
Design
: This frequentist, random-effects network meta-analysis (NMA) was prospectively registered
on PROSPERO (CRD42021282913) and conducted according to PRIMSA-NMA. Risk of bias (RoB)
and confidence of evidence were assessed by RoB-2 and CINeMA, respectively. Relevant
databases were searched from inception to October 9th, 2021.
Setting
: 124 (N=26,257) randomized controlled trials were included, of which 110 were analyzed.
Participants
: Trials enrolling adults (≥ 18) undergoing cardiac surgery which compared non-opioid
analgesics against other non-opioid analgesics, placebo, or no additional treatment,
as adjuvants to standard analgesic management, and reported at least one of the outcomes
of interest.
Measurement and Main Results
: Outcomes of interest included resting postoperative pain scores at 24-hours. Compared
with standard care/placebo, pain scores were significantly reduced by 10 different
regimens including acetaminophen (N=176; MD -0.66 points, 95% CI -1.16 to -0.15 points;
high confidence), magnesium (N=323; -0.05 points, 95% CI -0.07 to -0.02 points; high
confidence), gabapentin (N=96; MD -0.40 points, 95% CI -0.71 to -0.09; moderate confidence),
and clonidine (N=64; MD -0.38 points, 95% CI -0.73 to -0.04 points; moderate confidence).
Indomethacin, diclofenac, magnesium, and gabapentin led to significant reductions
in 24-hour opioid consumption. Four regimens significantly decreased ICU length of
stay (LOS). Hydrocortisone, dexmedetomidine and clonidine significantly decreased
the duration of mechanical ventilation. Magnesium decreased and methylprednisolone
significantly increased the risk myocardial infarction.
Conclusions
: Given the increasing importance of ERAS protocols and the eventual goal of limiting
opiate prescriptions postoperatively, our data suggests far greater use of non-opioid
adjuncts to minimize pain and enhance recovery.
Keywords
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Article info
Publication history
Publication stage
In Press Accepted ManuscriptFootnotes
PROSPERO Registration: CRD42021282913
Identification
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