Cochrane · systematic review · CD012624
Pre‐emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery
Doleman, B, Leonardi‐Bee, J, Heinink, TP, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
AnaesthesiaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
12
current version
GRADE rated
7
No studies
4
Included studies
NR
No studies 4 · 33.3%Ungraded 1 · 8.3%Very low 1 · 8.3%Low 4 · 33.3%Moderate 2 · 16.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Pre‐emptive opioids compared with postincision opioids for postoperative pain
Population: adults undergoing dental surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early acute postoperative pain ( Pre‐emptive opioids vs postincision opioids | no estimate extracted | 1 study · 40 participants | Low Downgraded: risk of bias, imprecision |
Respiratory depression (defined as SaO2 < 92%; yes/no during the postoperative period) Pre‐emptive opioids vs postincision opioids | no estimate extracted | NR | No studies |
Late acute postoperative pain (measured at 24 to 48 hours postoperatively using a validated pain scale, 0 no pain to 10 maximum pain) Pre‐emptive opioids vs postincision opioids | no estimate extracted | 1 study · 40 participants | Low Downgraded: risk of bias, imprecision |
24‐hour morphine consumption (mg) (if alternative opioids were used, we converted these to morphine equivalents using standard conversion factors) Pre‐emptive opioids vs postincision opioids | no estimate extracted | NR | No studies |
Intraoperative bradycardia (yes/no) Pre‐emptive opioids vs postincision opioids | no estimate extracted | NR | No studies |
Intraoperative hypotension (yes/no) Pre‐emptive opioids vs postincision opioids | no estimate extracted | NR | No studies |
Preventive opioids compared with postincision opioids for postoperative pain
Population: adults undergoing all types of surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Early acute postoperative pain ( Preventive opioids vs postincision opioids | no estimate extracted | 10 studies · 706 participants | Moderate Downgraded: risk of bias |
Respiratory depression (defined as SaO2 < 92%; yes/no during the postoperative period) Preventive opioids vs postincision opioids | no estimate extracted | 4 studies · 433 participants | Ungraded |
Late acute postoperative pain (measured at 24 to 48 hours postoperatively using a validated pain scale, 0 no pain to 10 maximum pain) Preventive opioids vs postincision opioids | no estimate extracted | 9 studies · 668 participants | Moderate Downgraded: risk of bias |
24‐hour morphine consumption (mg) (if alternative opioids were used, we converted these to morphine equivalents using standard conversion factors) Preventive opioids vs postincision opioids | no estimate extracted | 11 studies · 526 participants | Very low Downgraded: risk of bias, inconsistency, publication bias |
Intraoperative bradycardia (yes/no) Preventive opioids vs postincision opioids | RR 0.33 [0.01, 7.88] | 2 studies · 112 participants | Low Downgraded: risk of bias, imprecision |
Intraoperative hypotension (yes/no) Preventive opioids vs postincision opioids | RR 1.08 [0.25, 4.73] | 2 studies · 88 participants | Low Downgraded: risk of bias, imprecision |