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Afshan G, Khan RI, Ahmed A, Siddiqui AS, Rehman A, Raza SA, Kerai R, Mustafa K. Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review. BMC Anesthesiol 2021; 21:160. [PMID: 34034672 PMCID: PMC8152022 DOI: 10.1186/s12871-021-01375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. METHODS A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. RESULTS Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. CONCLUSION We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.
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Affiliation(s)
- Gauhar Afshan
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan.
| | - Robyna Irshad Khan
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Aliya Ahmed
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Ali Sarfraz Siddiqui
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Azhar Rehman
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Syed Amir Raza
- Faculty of Health Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, Pakistan
| | - Rozina Kerai
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
| | - Khawaja Mustafa
- Department of Anaesthesiology, 2nd floor Private Wing, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Pakistan
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