Reducing opioid consumption levels post-operatively following gastrointestinal surgery – A systematic review of randomized trials

Abstract

The opioid crisis has reached epidemic proportions worldwide. Unfortunately, prescription of opioid analgesia in the post-operative phase of treatment is contributing to this problem. We aimed to perform a systematic review of randomized controlled trials to establish methods of reducing opioid toxicity following gastrointestinal surgery. A systematic review was performed in accordance to the PRISMA guidelines. Randomized controlled trials were included. The risk of bias 2.0 assessment was used to determine potential bias. In total, 14 prospective, randomized trials involving 1,687 patients (mean age: 50 years (range: 21–80) were included in this systematic review. Overall, 42.9% of trials reported outcomes in relation to intravenous infusion of analgesia and their impact on opioid consumption at discharge (6/14), 5 trials of which reported reduced consumptions levels (5/6, 83.3%). Overall, 28.6% of studies assessed the role of oral medications reducing the requirement for opioids post-operatively (4/14), of which, just one trial reported a significant effect of oral vitamin C supplementation compared to placebo. Overall, just one trial outlined the impact of the use of patient-controlled analgesia, ultrasound-guided nerve blocks, intramuscular anti-inflammatory gels, and the role of opioid-specific counselling in reducing opioid consumption post-operatively. This systematic review adds further data to the surgical literature regarding efficacious methods to tackle the ‘opioid crisis’. Among the most promising avenues are opioid-specific counselling and peri‑operative prescription of intravenous infusions to counteract the increasing opioid consumption, which directly contributes to the ‘opioid epidemic’ for citizens across the world.