Ketamine 100mg/50ml / Morphine sulfate 100mg/50ml solution for infusion pre-filled syringes

IntroductionOpioids are commonly used for postoperative pain management but are associated with adverse effects and risk of dependence, potentially hindering recovery. This systematic review evaluates the impact of opioid-sparing analgesic strategies on postoperative pain and functional recovery to provide evidence-based guidance for clinical practice and future research.MethodsA comprehensive systematic review and meta-analysis was conducted by searching PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials on adult surgical patients from the inception of each database to July 10, 2024. The primary outcome was the total morphine consumption within 24 h postoperatively. Secondary outcomes included postoperative pain scores at 24 h, patient satisfaction, length of stay, quality of recovery, and opioid-related adverse effects, such as postoperative nausea and vomiting (PONV), sedation, dizziness, drowsiness, pruritus, urinary retention, and hypotension.ResultsA total of 58 studies (5614 patients) were included. The total morphine consumption was reduced, with a mean difference (MD) of -9.47, 95% confidence interval (95% CI) [-13, -5.95]. The postoperative pain score at 24 h was lower than in the control group, with an MD of -0.72 (95% CI [-0.97, -0.47]). Patient satisfaction was higher than in the control group, with an MD of 0.88 (95% CI [0.36, 1.40]). There were no significant differences in length of stay or recovery quality compared to the control group (P = 0.7, P = 0.48). The incidence of PONV was lower than the control group, with an odds ratio (OR) of 0.73 (95% CI [0.59, 0.90]), and the incidence of pruritus was also lower than in the control group, with an OR of 0.64 (95% CI [0.41, 0.98]). There were no differences in other adverse reactions compared to the control group.ConclusionThe results of this meta-analysis indicate that, compared to opioid-based analgesia, opioid-sparing analgesia is associated with reduced morphine consumption within 24 h postoperatively, lower pain scores, and a decreased incidence of PONV and pruritus. Patient satisfaction was also improved. The findings will help clinicians make evidence-based decisions for postoperative pain management.Trial registrationThe protocol for this meta-analysis: PROSPERO CRD42024579882.

Abstract licence: CC BY-NC

BACKGROUND: Postoperative pain remains a common clinical challenge, affecting patient recovery, satisfaction, and risk of chronic pain. Conventional analgesics often inadequately address the multifactorial nature of postoperative pain, while opioids carry risks of adverse effects and dependence. Multimodal analgesia, combining agents with complementary mechanisms, aims to improve pain control and reduce opioid consumption, but the incremental benefit of adding a second component is unclear. OBJECTIVE: To evaluate whether adding a second multimodal analgesic component to conventional regimens improves postoperative pain control and reduces opioid consumption in adult patients undergoing non-cardiac surgery. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials. PubMed and EMBASE (via Ovid) were searched for eligible studies up to August 2, 2024, using search terms related to surgical patients, pain, multimodal analgesia, and ten common multimodal components. We included RCTs in adults (≥ 18 years) undergoing non-cardiac surgery under general anesthesia, comparing standard care plus two multimodal components versus one component, with postoperative opioid consumption measured and pain measured by numeric rating scale (NRS) or visual analog scale (VAS). RESULTS: Twenty-seven trials were included. Meta-analysis of 17 trials (24 comparisons) showed that a second multimodal component reduces 24-hour opioid consumption by 5.2 mg oral morphine equivalents (95% CI[-7.7, -2.7]; p < 0.01; I² = 99%). Nineteen trials (29 comparisons) reported reduced pain scores at 4 h postoperatively by -0.5 points (95% CI[-0.8, -0.2]; I² = 94%). However, heterogeneity was very high. Subgroup analyses did not reveal a superior multimodal component. Adverse events were generally comparable, with some reductions in postoperative nausea and vomiting. Data on long-term outcomes and quality of recovery were limited. CONCLUSIONS: Adding a second multimodal analgesic component may modestly improve acute postoperative pain control and may reduce opioid consumption. Further research is needed to determine optimal combinations for specific surgical settings, to systematically evaluate associated adverse effects and to assess long-term outcomes including chronic pain prevention.

Abstract licence: CC BY-NC-ND