Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis

Autor: John W. Devlin, Yoanna Skrobik, Céline Gélinas, Michelle E. Kho, Ryan Grilli, Paul M. Szumita, Andre Gagarine, Carrie Price, Kathleen E. Wheeler, Waleed Alhazzani, Gerald Chanques, Mark E. Nunnally, Bram Rochwerg, Begüm Ergan, Shannon M. Fernando, John Centofanti, Janet Martin, John J. Lewin
Přispěvatelé: McMaster University [Hamilton, Ontario], McGill University = Université McGill [Montréal, Canada], Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), Northeastern University [Boston], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), New York University Langone Medical Center (NYU Langone Medical Center), NYU System (NYU), Dokuz Eylül Üniversitesi = Dokuz Eylül University [Izmir] (DEÜ), University of Ottawa [Ottawa], Johns Hopkins University (JHU), Johns Hopkins Medical Institutions, Herrada, Anthony, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Critical care explorations
Critical care explorations, Wolters Kluwer Health, 2020, 2 (7), pp.e0157. ⟨10.1097/CCE.0000000000000157⟩
Critical Care Explorations
Critical Care Explorations, 2020, 2 (7), pp.e0157. ⟨10.1097/CCE.0000000000000157⟩
ISSN: 2639-8028
DOI: 10.1097/CCE.0000000000000157⟩
Popis: Supplemental Digital Content is available in the text.
Objectives: This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU. Data Sources: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science. Study Selection: Two independent reviewers screened citations. Eligible studies included randomized controlled trials comparing efficacy and safety of an adjuvant-plus-opioid regimen to opioids alone in adult ICU patients. Data Extraction: We conducted duplicate screening of citations and data abstraction. Data Synthesis: Of 10,949 initial citations, we identified 34 eligible trials. These trials examined acetaminophen, carbamazepine, clonidine, dexmedetomidine, gabapentin, ketamine, magnesium sulfate, nefopam, nonsteroidal anti-inflammatory drugs (including diclofenac, indomethacin, and ketoprofen), pregabalin, and tramadol as adjunctive analgesics. Use of any adjuvant in addition to an opioid as compared to an opioid alone led to reductions in patient-reported pain scores at 24 hours (standard mean difference, –0.88; 95% CI, –1.29 to –0.47; low certainty) and decreased opioid consumption (in oral morphine equivalents over 24 hr; mean difference, 25.89 mg less; 95% CI, 19.97–31.81 mg less; low certainty). In terms of individual medications, reductions in opioid use were demonstrated with acetaminophen (mean difference, 36.17 mg less; 95% CI, 7.86–64.47 mg less; low certainty), carbamazepine (mean difference, 54.69 mg less; 95% CI, 40.39–to 68.99 mg less; moderate certainty), dexmedetomidine (mean difference, 10.21 mg less; 95% CI, 1.06–19.37 mg less; low certainty), ketamine (mean difference, 36.81 mg less; 95% CI, 27.32–46.30 mg less; low certainty), nefopam (mean difference, 70.89 mg less; 95% CI, 64.46–77.32 mg less; low certainty), nonsteroidal anti-inflammatory drugs (mean difference, 11.07 mg less; 95% CI, 2.7–19.44 mg less; low certainty), and tramadol (mean difference, 22.14 mg less; 95% CI, 6.67–37.61 mg less; moderate certainty). Conclusions: Clinicians should consider using adjunct agents to limit opioid exposure and improve pain scores in critically ill patients.
Databáze: OpenAIRE
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