In the presence of the worldwide opioid crisis, the use of opioid alternative medications offers an opportunity to reduce opioid exposure during and after surgery. However, the use of alternatives should be guided by rigorous research and improvement in outcomes that are important for patients (patient centered outcomes).
Goal
The primary goal of this study was to describe clinical trials evaluating the effect of opioid alternatives used during surgery on patient-centered outcomes. In other words, the research team was interested in exploring studies that looked into different choices of treatments, based on outcomes that were judged to be important, meaningful and impactful for people with lived experience.
MEthodology
The research team used a co-creation approach by involving people with lived experience, clinicians, methodologists, and partner organizations in the development of their review. They searched five databases for any clinical trials that investigated the effect of an opioid alternative on patient-centred outcome (i.e., outcomes that are important for patients) in adult surgical patients. The patient-centred outcomes of interest included: well-being, function, satisfaction, quality of life, life impact, long-term opioid use, opioid-related adverse effects, acute pain, and chronic pain following surgery.
Results
This review demonstrates that that patient-centred outcomes are rarely used to assess the benefits of opioid alternatives in clinical trials conducted in surgical patients. Amongst clinical trials that evaluated these patient-centred outcomes, three strategies appeared promising, namely: dexmedetomidine, systemic lidocaine, and COX-2 inhibitors. Some routinely used strategies were not supported by patient-centred outcomes (e.g. ketamine, gabapentinoids).
Take home message
In order to improve relevance and applicability of the findings, researchers should include patient-centered outcomes in the evaluation of opioid alternatives that can be used during surgery.
