Abstract
BackgroundUnrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade.MethodsA comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria.ResultsResults are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia.ConclusionWe found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries.Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review.
Highlights
MethodsA comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in low and middle income countries (LMIC)
Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC)
Transversus abdominis Plane (TAP) block comparing conventional and subcostal approaches was used in two randomized control trials (RCTs) [12, 21], and TAP block comparing two local anesthetics (LA) in one [14]
Summary
A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Search strategy A systematic literature search was conducted with the assistance of a librarian in PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify all relevant studies on the management of postoperative pain in LMIC. We used the list of LMICs generated by the World Bank which includes 47 countries with a gross national income (GNI) per capita between $1026 and $3995. We included all 47 countries as per the list in our Boolean search [11]. A total of 1450 randomized control trials (RCTs) were found out of 2196 in the pre-specified list of 47 countries
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