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BackgroundInadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects.ObjectiveTo identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy.Databases and data treatmentThis systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE.ResultsA total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions-including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin-were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia.ConclusionsMultiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice.SignificanceThe findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. However, the high risk of bias and low quality of evidence in many of the included trials necessitate cautious interpretation of the findings.

Abstract licence: CC BY

BACKGROUND: Post-endodontic pain is a common complication that negatively impacts patients’ daily lives. Single-dose oral analgesics are often prescribed after non-surgical root canal treatments to manage discomfort; however, their relative efficacy remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of different single-dose postoperative medications for pain relief following root canal treatment (RCT). METHODS: A comprehensive search of PubMed, Scopus, Embase, and Cochrane CENTRAL up to February 2025 was conducted to identify randomized controlled trials (RCTs) comparing single-dose postoperative analgesics with placebo in patients undergoing non-surgical endodontic treatment. Pain outcomes were assessed using Visual Analog Scales (VAS) at 6–8, 12, and 24 h post-treatment. Risk of bias was evaluated using the Cochrane RoB 2 tool. Pairwise and frequentist network meta-analyses were performed, and treatments were ranked using P-scores. RESULTS: Ten RCTs were qualitatively analyzed, while five of them were eligible for quantitative analyses and were included in our meta-analysis. They were from four countries with a combined sample size of 347 participants. At 6–8 h, Diclofenac + Acetaminophen provided the greatest pain reduction (MD: -6.28, 95% CI: -11.99 to -0.56), followed by Novafen and Ibuprofen + Acetaminophen. At 12 and 24 h, Novafen and Naproxen consistently demonstrated superior analgesic effects, whereas Tramadol and Ibuprofen offered moderate relief. Ibuprofen combinations with Acetaminophen or Alprazolam showed variable efficacy. Sensitivity analyses confirmed the robustness of these findings. CONCLUSIONS: Single-dose oral medications administered after non-surgical root canal treatments effectively reduce post-endodontic pain. Diclofenac + Acetaminophen is most effective for immediate short-term relief, while Novafen and Naproxen provide sustained efficacy at later time points. These results can guide clinicians in selecting optimal single-dose medications for post-RCT pain management. Keywords: postoperative endodontic pain; network meta-analysis; pain management; endodontic treatment TRIAL REGISTRATION: Not applicable.

Abstract licence: CC BY-NC-ND

BackgroundSerotonin syndrome (SS) is a potentially life-threatening condition increasingly driven by complex drug-drug interactions (DDIs) as serotonergic agents expand beyond psychiatry into pain management and infectious disease treatment. Current clinical decision support tools often exhibit inconsistencies in detecting these risks, leading to potential under-recognition of severe interactions.ObjectivesThis study aimed to detect and validate clinically significant DDIs associated with SS by integrating multisource real-world data. We sought to identify high-priority drug combinations, evaluate the concordance of major DDI checking tools, and highlight critical information gaps to improve patient safety strategies.DesignA multisource, retrospective study combining a systematic literature review, a disproportionality analysis of spontaneous adverse event reports, and a comparative cross-sectional evaluation of online DDI databases.MethodsThis study employed a multisource approach to detect and evaluate SS-related DDIs. We integrated findings from a systematic literature review (up to June 2025), a disproportionality analysis using the FDA Adverse Event Reporting System (FAERS) with four frequency statistical models, and a comparative assessment of five major DDI checkers (Micromedex, Lexi-Interact, Epocrates, Medscape, and Drugs.com).ResultsThe systematic review identified high-risk interactions involving not only antidepressants but also non-psychotropic drugs such as linezolid, fentanyl, and methylene blue. FAERS data revealed strong signals for combinations such as linezolid-sertraline and fentanyl-venlafaxine, indicating a rising trend in SS reporting over the past two decades. Evaluation of DDI checkers demonstrated significant discrepancies in sensitivity and severity grading. Notably, 10.16% were not indexed in any of the five databases, including several clinically documented DDIs (e.g., aripiprazole-paracetamol and trazodone-pantoprazole), highlighting critical information gaps.ConclusionSS remains a significant clinical risk driven by increasingly complex polypharmacy. Relying on a single DDI checker may lead to an underestimation of risk due to inconsistent indexing and severity ratings. Hospital pharmacists should integrate multisource data and maintain high clinical vigilance, particularly for "hidden" serotonergic agents such as certain opioids and antibiotics, to ensure medication safety.

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