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

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

Postoperative pain management modalities used for adult patients in LMIC – A systematic review of randomized controlled trials

Background: Unrelieved postoperative pain afflicts millions each year in LMIC. Despite substantial advances in the study of pain, this area remains neglected. Anesthesia and related specialties have been reporting the enormity of the burden of pain and suffering in LMIC citing disproportionately limited resources, lack of regulations, and paucity of pain education as main reasons Current systematic review was designed to the ascertain the types of modalities studied over the last decade in the LMIC for possible use in the management of postoperative pain in adult patients.Methodology: A comprehensive search was performed in December 2018 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant studies 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. After inclusion/exclusion criteria were ap[1]plied. 51 studies were included,Results: 11 trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional anesthesia. Different analgesic modalities were studied in four trials on thoracotomy but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In two trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopedic surgery, multimodal analgesia was used with some form of regional analgesia.Conclusion: Postoperative pain is managed by multimodal approach following common surgical procedures in LMIC. Some form of regional analgesia is frequently used. Though the small snapshot reflects practices according to the current guidelines, these results should be interpreted cautiously as majority of studies are small and heterogeneous