Original Article|Articles in Press

Comparative efficacy of adjuvant non-opioid analgesia in adult cardiac surgical patients: A network meta-analysis

Published:March 17, 2023DOI:



      : To compare the relative efficacy of adjuvant non-opioid analgesic regimens in adult cardiac surgical patients.


      : 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.


      : 124 (N=26,257) randomized controlled trials were included, of which 110 were analyzed.


      : 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.


      : 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.


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