Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta‐analysis

Qiu, Qinwei; Choi, S. W.; Wong, Stanley Sau Ching; Irwin, Michael G.; Cheung, Chi Wai

doi:10.1111/anae.13578

Cited by 61 publications

(57 citation statements)

References 41 publications

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“…The atmospheric temperatures in the operating theatre and the recovery area were not significantly different. Propofol and remifentanil are known to have short context‐sensitive decrement times . Second, this new index has not yet been confirmed to work well during general anaesthesia.…”

Section: Discussionmentioning

confidence: 93%

Development of a new analgesic index using nasal photoplethysmography

et al. 2018

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Although surrogate measures to quantify pain intensity have been commercialised, there is a need to develop a new index with improved accuracy. The aim of this study was to develop a new analgesic index using nasal photoplethysmography data. The specially designed sensor was placed between the columella and the nasal septum to acquire nasal photoplethysmography in surgical patients. Nasal photoplethysmography and Surgical Pleth Index (GE Healthcare) data were obtained for 14 min both in the absence (pre-operatively) or presence (postoperatively) of pain in a group of surgical patients, each patient acting as their own control. Various dynamic photoplethysmography variables were extracted to quantify pain intensity; the most accurate index was selected using logistic regression as a classifier. The area under the curve of the receiver-operating characteristic curve was measured to evaluate the accuracy of final model predictions. In total, 12,012 heart beats from 89 patients were used to develop a new Nasal Photoplethysmography Index for analgesic depth quantification. The two-variable model (a combination of diastolic peak point variation and heart beat interval variation) was most accurate in discriminating between the presence and absence of pain (numerical rating scale (NRS) ≥ 3). The accuracy and area under the curve of the receiver-operating characteristic curve for the Nasal Photoplethysmography Index were 75.3% and 0.8018, respectively, and 64.8% and 0.7034, respectively, for the Surgical Pleth Index. The Nasal Photoplethysmography Index clearly distinguished pain (NRS ≥ 3) in awake surgical patients with postoperative pain. The Nasal Photoplethysmography Index performed better than the Surgical Pleth Index. Further validation studies are needed to evaluate its feasibility to quantify pain intensity during general anaesthesia.

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Section: Discussionmentioning

confidence: 93%

Development of a new analgesic index using nasal photoplethysmography

et al. 2018

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“…The lack of standardisation of pain outcomes is not limited to paediatric populations, however. A recent systematic review of propofol for postoperative pain reported that seven primary studies could not be included as the different pain scoring systems were not interconvertible . This lack of consistency in pain measurement in adults suggests that standardisation for pain assessment is needed in all patient groups.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set

et al. 2018

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Systematic reviews of postoperative pain in children have called into question the consistency of outcomes measured by clinical triallists as well as the measurement instruments used for assessment. Core outcome set methodology may be a solution to improve standardisation. This study provides an evidence-based foundation for the development of a core outcome set for paediatric postoperative pain studies. We searched ClinicalTrials.gov to identify relevant postoperative pain studies in children. The search yielded 300 registered trials. The following data were then extracted from each of the trials: phase of trial; study type; study design; sample size; all outcomes; whether the outcome was listed as primary, secondary, or tertiary; the measurement instrument for each reported outcome; the specific metric for each outcome; and the type of clinical procedure. Following screening, 134 studies were included in our study. Pain measurement was the most commonly reported outcome (n = 123), followed by total postoperative analgesic dosage (n = 83) and side-effects (n = 25). Temporal trends indicated that pain assessment and unexpected events increased in use between 2000 and 2016, whereas postoperative analgesia measurement decreased. We found a lack of standardisation among outcomes and measurement instruments in paediatric postoperative pain studies. Development of a core outcome set may improve the quality of future trials and allow for more accurate study-to-study comparisons.

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“…However, with TIVA, we control anaesthesia/consciousness with one drug (propofol) and analgesia with another (a titratable opioid such as remifentanil). Propofol is a powerful hypnotic drug but not a conventional analgesic , although it does have activity at hyperpolarisation‐activated cyclic nucleotide‐gated channel‐1 (HCN1) receptors and anti‐inflammatory effects which reduce postoperative pain . This is an important distinction but one which may also have advantages now that there is increasing concern over the adverse effects of excessively deep anaesthesia .…”

Section: Lost In Translationmentioning

confidence: 99%

“…Quality of recovery is one of the most obvious, well‐known and tangible benefits of propofol‐based TIVA, but others are becoming apparent. Patients appear to have less pain than after inhalational anaesthesia and there is less impact on neurocognitive function . There may even be survival advantages in cancer surgery , with plausible mechanistic support .…”

mentioning

confidence: 98%