Effectiveness of Interventions to Reduce Opioid Use After Orthopaedic Surgery: A Systematic Review of Randomised Controlled Trials.

Autor: Hamilton M; Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney Musculoskeletal Health, Sydney, Australia. melanie.hamilton@sydney.edu.au.; Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, NSW, 2050, Australia. melanie.hamilton@sydney.edu.au., Mathieson S; Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney Musculoskeletal Health, Kolling Institute, Sydney, Australia., Jamshidi M; Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney Musculoskeletal Health, Sydney, Australia.; Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, NSW, 2050, Australia., Wang A; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia., Lee YC; Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.; Pain Management Centre, Royal Prince Alfred Hospital, Sydney, Australia., Gnjidic D; Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia., Lin CC; Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney Musculoskeletal Health, Sydney, Australia.; Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, NSW, 2050, Australia.
Jazyk: angličtina
Zdroj: Drugs [Drugs] 2024 Dec 20. Date of Electronic Publication: 2024 Dec 20.
DOI: 10.1007/s40265-024-02116-2
Abstrakt: Background: The prescribing of opioids to patients for postoperative pain can lead to persistent opioid use. This review investigated the effectiveness of interventions aimed at reducing opioid use in patients after orthopaedic surgery.
Methods: Electronic databases were searched from inception to November 2023. We included randomised controlled trials investigating interventions aimed at reducing opioid use after orthopaedic surgery. Two reviewers conducted the screening and data extraction and assessed the risk of bias (Cochrane Risk of Bias tool) and certainty of evidence (GRADE). The primary outcome was the mean daily dose of opioid analgesic medications in the medium term (1-3 months after randomisation). Results were pooled in a meta-analysis using a random-effects model where appropriate (e.g. I 2 < 50%) or summarised narratively.
Results: The search yielded 17,471 records, of which 39 trials were included. High heterogeneity meant that most comparisons could not be pooled. The mean daily dose was lower with multimodal analgesia interventions than with placebo/no intervention/usual care or active control in the medium term. No between-group differences were found between other pharmacological or non-pharmacological interventions and either placebo/no intervention/usual care or active control at the medium-term time point. The certainty of evidence ranged from low to moderate.
Conclusions: Multimodal analgesic interventions may reduce opioid use compared with placebo/no intervention/usual care or active control in the medium term. However, the high heterogeneity and low certainty of evidence means it is uncertain which interventions are effective in reducing opioid use after orthopaedic surgery.
Competing Interests: Declarations. Funding: Open Access funding enabled and organized by CAUL and its Member Institutions. Conflict of interest: CL is supported by a National Health and Medical Research Council (NHMRC) Emerging Leadership Investigator Grant (1193939). All other authors have no conflicts of interest to declare. Ethics approval: Ethical approval was not required to conduct this review. Consent: Not applicable. Data availability: The data that support the findings of this study are available from the corresponding author upon reasonable request. Code availability: Not applicable. Author contributions: MH, SM, DG, and CL conceived the review. All authors contributed to and agreed on the review protocol. MH conducted the search. MH, SM, and MJ conducted the screening. All authors extracted data. MH, SM, MJ, DG, and CL conducted data analysis and interpretation. MH wrote the first draft. All authors critically reviewed the manuscript and approved the final draft for submission.
(© 2024. The Author(s).)
Databáze: MEDLINE
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