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PreprintCited by 7Anesthesia and Pain ManagementPain Management and Opioid UsePediatric Pain Management Techniques

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: a systematic review

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Afshan, Gauhar, Khan, Robyna Irshad, Ahmed, Aliya, Siddiqui, Ali Sarfraz, Rehman, Azhar, Raza, Syed Amir, Kerai, Rozina, Mustafa, Khawaja·2020·BMC Anesthesiology
DOI 10.21203/rs.3.rs-54698/v1PMC PMC8152022

Preprint — published as 10.1186/s12871-021-01375-w · Paper page

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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.

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Authors
Afshan, G., Khan, R. I., Ahmed, A., Siddiqui, A. S., Rehman, A., Raza, S. A., Kerai, R., & Mustafa, K.
Affiliations
Aga Khan University (PK)
Corresponding author
Afshan, Gauhar
ORCID
Venue
BMC Anesthesiology
Publisher
Springer Science and Business Media LLC
Published
2020-08-14
Volume
21
Issue
1
Pages
160-160
ISSN
1471-2253 (ISSN-L)
DOI
10.21203/rs.3.rs-54698/v1
PMC
PMC8152022
OpenAlex
W3116244335
Cited by
7
References
61
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1
FWCI
0.24
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Anesthesiology (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
postoperative pain management, multimodal analgesia, regional analgesia, clinical trial evidence, low- and middle-income countries, laparoscopic cholecystectomy, thoracotomy, laparotomy, hysterectomy, breast surgery, orthopedic surgery, preemptive analgesia, pregabalin, gabapentin, rescue analgesia
MeSH terms
Adult, Developing Countries, Humans, Postoperative Pain, Poverty, Comorbidity, Healthcare Disparities, Pain Management

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