Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials

• Published in: Journal of clinical medicine Vol. 13; no. 7; p. 2100
• Main Authors: Carron, Michele, Tamburini, Enrico, Linassi, Federico, Pettenuzzo, Tommaso, Boscolo, Annalisa, Navalesi, Paolo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.04.2024
• Subjects: Adjuvants; Adults; Analgesics; Bias; Clinical trials; Comparative analysis; Demographic aspects; Dosage and administration; Drug therapy; Gastrointestinal surgery; General anesthesia; Immunological adjuvants; Ketamine; Medical Subject Headings-MeSH; Meta-analysis; Narcotics; Nonsteroidal anti-inflammatory drugs; Obesity; Pain management; Pain, Postoperative; Patient outcomes; Patients; Physiology; Postoperative period; Systematic review; Italy; complications; postoperative pain; analgesia; postoperative recovery; treatment outcome; combined-modality therapy; obesity; anesthesia; postoperative nausea and vomiting; surgery
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13072100

Background/Objectives: Managing postoperative pain in patients with obesity is challenging. Although using a combination of pain relief methods is recommended for these patients, the true effectiveness of various intravenous non-opioid analgesics and adjuvants in multimodal anesthesia needs to be better defined. Methods: A systematic review and network meta-analysis was performed to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ketamine, α-2 agonists, lidocaine, magnesium, and oral gabapentinoids in adult surgical patients with obesity. The analysis aimed to compare these treatments to a placebo/no treatment or alternative analgesics, with a primary focus on postoperative pain and secondary endpoints including rescue analgesia, postoperative nausea and vomiting (PONV), and recovery quality. English-language randomized controlled trials across PubMed, Scopus, Web of Science, CINAHL, and EMBASE were considered. Quality and evidence certainty were assessed with the RoB 2 tool and GRADE, and data was analyzed with R software. Results: NSAIDs, along with acetaminophen, lidocaine, α-2 agonists, ketamine, and oral gabapentinoids, effectively reduce early postoperative pain. NSAIDs, particularly ibuprofen, as well as acetaminophen, ketamine, and lidocaine, also show benefits in later postoperative stages. Intravenous non-opioid analgesics and adjuvants show some degree of benefit in reducing PONV and the need for rescue analgesic therapy when using α-2 agonists alone or combined with oral gabapentinoids, notably decreasing the likelihood of PONV. Ketamine, lidocaine, and α-2 agonists are shown to enhance postoperative recovery and care quality. Conclusions: Intravenous non-opioid analgesics and adjuvants are valuable in multimodal anesthesia for pain management in adult surgical patients suffering from obesity.