Dataset Information

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

ABSTRACT: 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.

SUBMITTER: Wheeler KE

PROVIDER: S-EPMC7340332 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

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

Wheeler Kathleen E KE Grilli Ryan R Centofanti John E JE Martin Janet J Gelinas Celine C Szumita Paul M PM Devlin John W JW Chanques Gerald G Alhazzani Waleed W Skrobik Yoanna Y Kho Michelle E ME Nunnally Mark E ME Gagarine Andre A Ergan Begum A BA Fernando Shannon S Price Carrie C Lewin John J Rochwerg Bram B

Critical care explorations 20200706 7

This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU.<h4>Data sources</h4>We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science.<h4>Study selection</h4>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.<h4>Data extraction</h4>We conduct ...[more]

PMID: 32696016

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Dataset Information

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

Data sources

Study selection

Data extraction

Data synthesis

Conclusions

Publications

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

Similar Datasets

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