Systematic Reviews/Meta-Analysis
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Background: Multi-modal analgesic regimens have the potential to deliver opioid-sparing pain management. While their efficacy has largely been established, the impact of adverse drug effects (ADEs) associated with this analgesic strategy have not been fully investigated.
Methods: A systematic review was conducted in Embase, MEDLINE (PubMed), Cochrance CENTRAL, and Web of Science, SciELO, and Korean Citation Index (Clarivate) on 6 February 2023. Bias was evaluated using the Cochrane Risk of Bias tool. Studies documenting an ADE associated with a non-opioid medication used as an analgesic in conjunction with an opioid in non-intubated intensive care patients were included.
Results: Ten randomized control trials were included in the qualitative synthesis after 961 records were assessed for eligibility. Medications evaluated included acetaminophen, lidocaine, dexmedetomidine, gabapentin, pregabalin, carisoprodol, ketorolac, ibuprofen, and ketamine. All but three of the evaluated trials used >1 adjunctive analgesic as part of a comprehensive pain management regimen. None of the trials documented a clinically significant increase in the incidence of adverse drug effects versus their comparator groups. The ADEs evaluated aligned with the contributing medications: Ketamine was associated with mental status changes, IV lidocaine with urinary retention, and gabapentin with dizziness.
Discussion: The findings of this review support the safety of using multi-modal analgesic strategies, and can be further extrapolated to endorse the use of multiple adjunctive agents simultaneously to safely deliver an adequate pain management regimen. The inability to quantify the effects of a single adjunctive agent’s safety profile is a limitation, however; the lack of identified differences in the ADE incidence rate obtained from the primary literature make it reasonable to consider them safe for the vast majority of patients.
Other: None of the authors have any relevant conflicts of interest to disclose.
Presenting Author
Justin Reinert Pharm.D., MBA, BCCCPThe University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy
Authors
Wade Lee-Smith BS, MLS
The University of Toledo, University Libraries
Cole Jerousek Pharm.D. Candidate, 2023
The University of Toledo College of Pharmacy and Pharmaceutical Sciences