Abstract ID: A24

Abstract Title: A Systematic Review of the Efficacy of Sustained-release Opioids for Postoperative Analgesia

Authors: Murphy J1, Hanna M2, Richman J3, Wu C4
         The Johns Hopkins University Baltimore MD USA1, The Johns Hopkins University Baltimore MD USA2, The Johns Hopkins University Baltimore MD USA3, The Johns Hopkins University Baltimore MD USA4
Poster Type: Poster


ABSTRACT BODY

Introduction:
Postoperative pain continues to be a problem due to a variety of reasons including technology-related analgesic gaps and underassessment of pain. Use of a sustained-release opioid preparation might negate some of the issues related to postoperative pain management and improve postoperative analgesia. We performed a systematic review of available trials investigating a comparison of sustained-release opioid preparation to either placebo or an immediate-release opioid for the treatment of postoperative pain.
Materials and Methods:
The National Library of Medicine's PubMed database was searched for the time period 1966 to August, 2005 for all relevant articles. The reference lists of accepted articles were hand searched for additional articles. Inclusion criteria included subjects undergoing surgical procedures, trials that investigating a sustained-release opioid preparation for postoperative pain control and compared the effectiveness of the sustained-release formulation to either placebo or an immediate-release opioid, and where the postoperative pain was measured and documented.
Results:
Our search resulted in 15 abstracts of which a total of 10 articles met all inclusion criteria. There were 386 subjects who received a sustained-release opioid preparation for control of postoperative pain and 386 subjects who did not (total = 772 subjects). Eight of the 10 articles examined inpatient postoperative pain. Due to the presence of excessive heterogeneity, a pooled estimate (meta-analysis) was not performed. Four of the 10 articles examined use only a single dose of sustained-release opioid whereas the reminder used a multiple dosing regimen. Seven of the 10 studies demonstrated that use of a sustained-release opioid (compared to either placebo or an immediate-release opioid) is associated with a decrease in postoperative pain.
Discussion:
Our systematic review indicates that use of a sustained-release opioid is associated with a decrease in postoperative pain when compared to a regimen using either placebo or an immediate-release opioid. Significant methodologic issues are present and additional studies are needed to examine the analgesic efficacy of a sustained-release opioid regimen in different settings (i.e., different surgical populations, inpatient versus outpatient, transition from IV PCA/PCEA to oral analgesics)

ATTACHED FILES

A24_ASRA-2006-murphy-abstract-table.doc





Reg Anesth Pain Med 2005; 30(3):A24