AI Article Synopsis
- Managing postoperative pain for patients with obesity is complicated, and this study explores the effectiveness of various nonopioid intravenous analgesics and adjuvants in reducing opioid use and recovery complications after surgery.
- A systematic review of 37 randomized controlled trials found that medications like dexmedetomidine, ketamine, lidocaine, and gabapentin significantly decreased opioid consumption and postoperative issues such as nausea and vomiting in these patients.
- The findings suggest that these nonopioid analgesics are vital in improving postoperative care, ultimately leading to better outcomes for obese patients undergoing surgery.
Article Abstract
Background: Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity.
Methods: A systematic review and network meta-analysis was performed. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched. Only English-language RCTs investigating the use of nonopioid analgesics and adjuvants in adult surgical patients with obesity were included. The quality of evidence and certainty were assessed using the RoB 2 tool and GRADE framework, respectively.
Results: In total, 37 RCTs involving 3602 patients were included in the quantitative analysis. Compared with placebo/no intervention or a comparator, dexmedetomidine, ketamine, lidocaine, magnesium, and gabapentin significantly reduced postoperative opioid consumption after surgery. Ketamine/esketamine also significantly reduced POPCs. Ibuprofen, dexmedetomidine, and lidocaine significantly reduced postoperative nausea, whereas dexmedetomidine, either alone or combined with pregabalin, and lidocaine reduced postoperative vomiting. Dexmedetomidine significantly reduced PACU LOS, whereas both paracetamol and lidocaine reduced hospital LOS.
Conclusions: Intravenous nonopioid analgesics and adjuvants are crucial in multimodal anaesthesia, reducing opioid consumption and enhancing postoperative care in adult surgical patients with obesity.
Systematic Review Protocol: CRD42023399373 (PROSPERO).
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| http://dx.doi.org/10.1016/j.bja.2024.08.009 | DOI Listing |
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