Funding The main reviewer (DA) is funded by Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia and the Saudi Arabian Cultural Bureau in London, UK. This review will be part of DA’s PhD study at the University of Aberdeen.Peer reviewedPublisher PD

Adam, Rosalind

Aljohani, Dalia Mohammed S

Almalki, Nabat

Forget, Patrice

English

Funding The main reviewer (DA) is funded by Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia and the Saudi Arabian Cultural Bureau in London, UK. This review will be part of DA’s PhD study at the University of Aberdeen.Peer reviewe

Aberdeen University Research

EJAIC Eur J Anaesthesiol Intensive Care Med 2023; 2:3(e0024)Downloaded from http://journals.lww.com/ejaintensivecare by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/16/2023FroIns(DScCoInsE-27ThpeREVIEW ARTICLEExperiences and perspectives of adults on using opioidsfor pain management in the postoperative periodA scoping review protocolDalia Mohammed Aljohani, Nabat Almalki, Rosalind Adam and Patrice ForgetOBJECTIVE To identify and examine the available studiesregarding adult perceptions and experiences of postopera-tive opioid pain management.INTRODUCTION The opioid crisis has been acknowledgedas a significant clinical and social problem in many countries.Opioids are often initiated after surgery and may be contin-ued on hospital discharge. There is no consensus on theoptimal strategy for integrating patients’ views in postopera-tive opioid prescribing. The aim of this review is to explore theliterature on adults’ experiences with postoperative opioidpain management.INCLUSION CRITERIA This review will consider all qualita-tive studies and mixed-method studies with qualitativeapproaches that explored adults’ opinions or concerns onopioids and/or opioid reduction, and adults’ satisfaction withpain control in this context. Participants in the studies shouldbe adults who had undertaken any type of surgery and havehad opioid prescriptions for pain management.m the Pain ANDOpioids after Surgery (PANDOS) European Society of Anaesthesioltitute of Applied Health Sciences, University of Aberdeen, Health Sciences BuildinMA), Department of Nursing, Prince Sultan Military College of Health Sciences, Diences, University of Aberdeen (RA), Department of Anaesthesia, Aberdeen Royalrrespondence to Dalia Mohammed Aljohani, BSc, MSc, Department of Anesthestitute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.mail: johani.dalia@gmail.com67-7206 Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inis is an open access article distributed under the terms of the Creative Commons Armissible to download and share the work provided it is properly cited. The work cannMETHODS This scoping review will be carried out in accor-dance with the Joanna Briggs Institute (JBI) methodologyand will utilise the Preferred Reporting Items for SystematicReviews and Meta Analyses extension for scoping reviews(PRISMA-ScR) reporting guideline and checklist. Searcheswill be conducted in Ovid MEDLINE, PsycInfo, EMBASE andCINAHL (EBSCO). Studies published in the English lan-guage will be included with no time limit. The screening andselection of studies will be carried out independently by threereviewers. Then data extraction process will be conducted bythe main reviewer and the reviewer’s supervisors indepen-dently. A descriptive qualitative content analysis will beutilised for data synthesis. The final report will contain amethodological quality assessment, with the findings beingpresented, including the knowledge gaps and recommenda-tions for research.Published online 25 May 2023KEY POINTS This protocol will be used to conduct a scopingreview to identify existing literature regarding adultperceptions and experiences of postoperative opioidpain management. All qualitative studies and mixed methods-studydesigns with a qualitative approach will be includedin the review.ogghIniacttrot The JBI Critical Appraisal Checklist for QualitativeResearch will be used to conduct critical appraisals ofthe methodological quality of the included studies. The final report from the data extraction process willbe organised into themes and displayed in tabulary a, FoahrafirmTec. onibutbeform accompanied by a narrative summary.nd Intensive Care (ESAIC) Research Group (DMA, PF), Epidemiology Group,resterhill, Aberdeen, UK (DMA, PF), Department of Anesthesia Technologyn, Saudi Arabia (NA), Academic Primary Care, Institute of Applied Healthary, NHS Grampian, Aberdeen, UK (PF)hnology, Prince Sultan Military college of Health Sciences, Saudi Arabia,behalf of the European Society of Anaesthesiology and Intensive Care.DOI:10.1097/EA9.0000000000000024ion-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it ischanged in any way or used commercially without permission from the journal.2 Aljohani et al. EJAICDownloaded from http://journals.lww.com/ejaintensivecare by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/16/2023IntroductionControlling postoperative pain is essential for successfulsurgical recovery. Opioid prescriptions have been recog-nisedas a significant contributor to thepresent opioid crisis.1Numerous studies conducted in the UnitedKingdom (UK)indicate an increase in opioid prescriptions and usage in theNational Health Services (NHS). There have been manyefforts tominimise and limit opioid prescriptions. Althoughopioid prescriptions guidelines have been published,2–6neither their impact nor their rate of adoption have beenthoroughly examined.7 When developing pain manage-ment plans, it is important to consider patients’ concerns.Patients’ ideas and expectations can influence how theyexperience postoperative pain.7 If inadequate access toopioid needs to be prevented, over-reliance may also bea problem.8,9 Recently, amputee patients had significantconcerns about over-reliance on opioids for postoperativepain management and potential side effects of opioids.10Additionally, patients declared that they were prescribedmore opioids than they really needed;7 hence opioidsmightbe discarded improperly. In light of the efforts of opioidtapering, the literature recommended that pain manage-ment couldbe enhancedbyunderstandingpatients’ experi-ences and applying patient-centred care principles toprevent situations when patients endure unnecessary painwhile recovering from surgery.7,10Inmanycountries, theopioid crisis isnowwidely recognisedas a problem. In the UK, over the past decade, there hasbeen an estimated 400% increase in the use of prescriptionopioids.11 During 2017–2018, 12.8% of people in Englandreceived an opioid prescription, with about 50%using themfor at least a year.12 It is currently known that opioids areinvolved in almost half of drug deaths in England (Office ofNational Statistics 2021).13 In Scotland, 89% of the totaldrug-related deaths were caused by opioids (Drug-relateddeaths in Scotland in 2020).14 Scotland has a significantlyhigher rate of drug use than the rest of the UK.15 Theprevalence and consistency of opioid use (at least in theUK)16 and the increasing opioid-related deaths, must bebalanced against the necessity of adequate pain manage-ment after surgery (possibly with opioids), thus it is crucialthat researchers explore adults’ experiences and wishesregarding postoperative opioid pain management.A scoping review is a suitable method to identify thecurrent literature and to provide a thorough and compre-hensive summary of the evidence that exists regarding thistopic.17 Therefore, this review aims to identify and mapthe existing evidence related to patients’ experiencesregarding postoperative opioid pain management. A pre-liminary search of MEDLINE, the Cochrane Database ofSystematic Reviews and JBI Evidence Synthesis revealedno systematic studies or scoping reviews that are currentlyin progress or that have been published on this topic.To ensure comprehensive coverage of the topic underreview, we have a wide definition of the word ‘experi-ences’ in the review questions. It will include patients’Eur J Anaesthesiol Intensive Care Med 2023; 2:3concerns about using opioids, opinions/thoughts onopioids and/or opioid reduction and/or patients’ satisfac-tion with pain control.Review questions(1) W(e0hat evidence has been published regarding adultperceptions and experiences of postoperative opioidpain management?(2) What are adults’ opinions and concerns aboutpostoperative opioid pain management?(3) What are the literature gaps related to adultperceptions and experiences of postoperative opioidpain management?Eligibility criteriaParticipantsThe target population is adults who underwent any typeof surgery where they had opioid prescriptions forpain management.ConceptInclusion criteria: qualitative studies and mixed-methodstudies with a qualitative approach that explored adults’opinions or concerns on opioids and/or opioids reduction,and adults’ satisfaction with the use of opioid for paincontrol. Any opioids available for use in the UK, forexample, buprenorphine, codeine, hydrocodone, oxyco-done, diamorphine, dihydrocodeine, dipipanone, fenta-nyl, hydromorphone, morphine, meptazinol, methadone,pentazocine, pethidine, tapentadol or tramadol.Exclusion criteria: all types of quantitative studies, effi-cacy and effectiveness studies, RCT studies, and studiesinvestigating the use of opioids for nonpostoperative painmanagement will be excluded. In addition, studies thatexplored practitioners’ opinions on opioid for pain man-agement will not be considered.ContextThe review will include all qualitative studies, irrespec-tive of adults’ gender, age, race or geographic location.Types of sourcesThis scoping review will consider all qualitative studies,and mixed-methods study designs with a qualitativeapproach. Efficacy studies and effectiveness studies ofanalgesic techniques, review and opinion papers will beexcluded in this scoping review.MethodsThe proposed scoping review will be carried out inaccordance with the JBI methodology17 and will utilisethe Preferred Reporting Items for Systematic Reviewsand Meta Analyses extension for scoping reviews(PRISMA-ScR)18 reporting guideline and checklist toguarantee that the knowledge synthesis will be carriedout rigorously and credibly. Although scoping reviews donot synthesise the results,19,20 descriptive qualitative024)A scoping review protocol 3EJAICDownloaded from http://journals.lww.com/ejaintensivecare by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/16/2023content analysis will be used to organise and synthesisethe outcome, thus, addressing the review’s objective.KeywordsIn different databases and using a preformatted searchstrategy, we will consider the following keywords andtheir derivates: Adults’ perceptions; adults’ experiences;postoperative opioid; pain management; patients.Search strategyThe first step was an initial limited search of OvidMEDLINE, PsycInfo and Google Scholar performedto identify relevant articles, and the index terms usedto describe the article and subsequently to develop a fullsearch strategy (see Appendix 1, http://links.lww.com/EJAIC/A37). A second search will be undertaken by usingall identified keywords and terms via databases includedOvid MEDLINE, PsycInfo, EMBASE and CINAHL(EBSCO). Thirdly, the reference list of included studieswill be checked for additional appropriate studies.As the review aims to provide a thorough overview of theliterature on the topic over time, there will be no timerestrictions. Studies published in the English languagefrom any geographic context will be included.Study/source of evidence selectionMendeley will be used to upload research records fromdatabases. Duplicates studies will be removed, and theremaining studies will be screened and selected based onpredefined inclusion criteria via Rayyan 21 by threereviewers: the main reviewer and her supervisor, and aPhD student. Then, all remaining sources of evidencewillbe explored in full text form and revised by the reviewer’ssupervisors. Reasons for exclusion of any full text evidencewill be recorded.Anydiscrepancies that occur between thereviewers about the selection process will be managedthroughdiscussionorwith thehelp of another reviewer.Toreport and represent the inclusion and exclusion process,the PRSMA-ScR flow diagram will be followed.19Data extractionThe focus of the data extraction and synthesis stage will beon identifying and charting data regarding adults’ percep-tions and experiences of postoperative opioid painmanage-ment. The most appropriate data extraction tool for thescoping review with limited synthesis will be adopted (seeAppendix II, http://links.lww.com/EJAIC/A37).22 The dataextraction table illustrates thedetails of data extraction fromstudies that include study author/location, year of publica-tion, method, aim, participants, studies’ main themes, stud-ies’ findings appropriate for the review, conclusions,limitations/strengths mentioned by the authors and studyrecommendations. A descriptive thematic summary of thekey findings will be presented in a separate table. The dataextraction process will be conducted independently by themain reviewer (DMA) and the reviewer’s supervisors (PF,Eur J AnaesRA).Anyamendments of thedata extractionmethodwill bedetailed in the scoping review report.Assessment of methodological qualityAlthough no critical appraisal of evidence is required inscoping reviews as per PRISMA-ScR, the reviewers haveagreed to include an assessment ofmethodological quality.The JBI’s standardised tools will be used to conductcritical appraisals of the methodological quality of thestudies included.23 For example: the JBICritical AppraisalChecklist for Qualitative Research (Appendix III, http://links.lww.com/EJAIC/A37). The critical appraisal processwill offer a comprehensive analysis of the qualities of theevidence pertinent to opinions and experiences of adultsregarding postoperative opioid pain management. Thecritical appraisal will be reported in the results section.Data analysis, interpretation and presentationThe final report from data extraction process will beorganised into themes and displayed in tabular form ac-companied by a narrative summary in an accordance withthis scoping review’s objective. Interpretation will includeconcordant and discordant aspects with similar and relatedliterature. Knowledge gaps will be identified, as well aslimitations, allowing us to propose recommendations forresearch before concluding on the main findings.ConclusionThe findings of this review will be disseminated throughpublication and presentations at conferences.Acknowledgements relating to this articleAssistance with the study: none.Financial support and sponsorship: the main reviewer (DMA) isfunded by Prince Sultan Military College of Health Sciences,Dhahran, Saudi Arabia and the Saudi Arabian Cultural Bureau inLondon, UK. This review will be part of DMA’s PhD study at theUniversity of Aberdeen.Conflicts of interest: PF received advisory board/speaker fees fromOncomfort/Grunenthal. The other authors have no other conflict ofinterest to disclose.Presentation: none.This manuscript was handled by Marc Van de Velde.References1 Do U, Pook M, Najafi T, et al. S110—Opioid-free analgesia after outpatientgeneral surgery: a qualitative study focused on the perspectives of patientsand clinicians involved in a pilot trial. Surg Endosc 2022; 37:2269–2280.2 Chou R, Gordon DB, de Leon-Casasola OA, et al. Management ofpostoperative pain: a clinical practice guideline from the American pain society,the American Society of Regional Anesthesia and Pain Medicine, and theAmerican Society of Anesthesiologists’ committee on regional anesthesia,executive committee, and administrative council. J Pain 2016; 17:131–157.3 OvertonHN,HannaMN,BruhnWE,et al., OpioidsAfterSurgeryWorkgroup.Opioid-prescribing guidelines for common surgical procedures: an expertpanel consensus. J Am Coll Surg 2018; 227:411–418.4 Thiels CA, Ubl DS, Yost KJ, et al. Results of a prospective, multicenterinitiative aimed at developing opioid-prescribing guidelines after surgery.Ann Surg 2018; 268:457–468.thesiol Intensive Care Med 2023; 2:3(e0024)4 Aljohani et al. EJAICDownloaded from http://journals.lww.com/ejaintensivecare by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/16/20235 Hill MV, Stucke RS, Billmeier SE, et al. Guideline for discharge opioidprescriptions after inpatient general surgical procedures. J Am Coll Surg2018; 226:996–1003.6 Srivastava D, Hill S, Carty S, et al. Surgery and opioids:evidence-based expert consensus guidelines on the perioperativeuse of opioids in the United Kingdom. Br J Anaesth 2021; 126:1208–1216.7 Pius AK, Jones E, Bonnell LN, et al. Patients’ experience with opioid painmedication after discharge from surgery: a mixed-methods study. J SurgRes 2020; 256:328–337.8 Forget P, Patullo C, Hill D, et al. System-level policies on appropriateopioid use, a multistakeholder consensus. BMC Health Serv Res 2022;22:1–8.9 Adams TJ, Aljohani DM, Forget P. Perioperative opioids: a narrative reviewcontextualising new avenues to improve prescribing. Br J Anaesth 2023;S0007-0912(23)00124-1.10 Milosevic S, Strange H, Morgan M, et al. Exploring patients’ experiences ofanalgesia after major lower limb amputation: a qualitative study. BMJ Open2021; 11:e054618.11 Basler MH. Could we see a prescription opioid epidemic in the UK? BMJ2017; 356:j790.12 Marsden J, White M, Annand F, et al. Medicines associated withdependence or withdrawal: a mixed-methods public health reviewand national database study in England. Lancet Psychiatry 2019; 6:935–950.13 Office of National Statistics. Deaths related to drug poisoning in England andWales. 2021 registrations. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2021registrations.[Accessed: 23 January 2023]Eur J Anaesthesiol Intensive Care Med 2023; 2:314 Drug-related deaths in Scotland in 2020. Available at: https://www.nrscotland.gov.uk/files//statistics/drug-related-deaths/20/drug-related-deaths-20-pub.pdf. [Accessed: 27 January 2023]15 Alenezi A, Yahyouche A, Paudyal V. Current status of opioid epidemic in theUnited Kingdom and strategies for treatment optimisation in chronic pain.Int J Clin Pharm 2021; 43:318–322.16 Xia Y, Forget P. Opioid and gabapentinoid prescriptions in England from2015 to 2020. PLoS One 2022; 17:e0276867.17 Pham MT, Rajić A, Greig JD, et al. A scoping review of scoping reviews:advancing the approach and enhancing the consistency. Res SynthMethods 2014; 5:371–385.18 Peters MDJ, Godfrey C, McInerney P, et al. Chapter 11: scoping reviews(2020 version). In: Aromataris E, Munn Z (Editors). JBI manual for evidencesynthesis, JBI, 2020. Available at: https://synthesismanual.jbi.global.[Accessed: 12 December 2022]19 Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews(PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467–473.20 Peters MD, Godfrey C, McInerney P, et al. Best practice guidance andreporting items for the development of scoping review protocols. JBI EvidSynth 2022; 20:953–968.21 Mourad O, Hossam H, Zbys F, et al. Rayyan — a web and mobile app forsystematic reviews. Syst Rev 2016; 5:210.22 Noyes J, Booth A, CargoM, et al. Chapter 21: Qualitative evidence. In: HigginsJPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ,Welch VA (editors). Cochrane Handbook for Systematic Reviews ofInterventions version 6.3 (updated February 2022). Cochrane, 2022. Availableat: www.training.cochrane.org/handbook [Accessed: 02 February 2023]23 JBI critical appraisal tools. Available at: https://jbi.global/critical-appraisal-tools [Accessed: 19 December 2022](e0024)

Experiences and perspectives of adults on using opioids for pain management in the postoperative period : A scoping review protocol.

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Experiences and perspectives of adults on using opioids for pain management in the postoperative period : A scoping review protocol.

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