Influence of high-dose intraoperative remifentanil with intravenous ibuprofen on postoperative morphine consumption in patients undergoing pancreaticoduodenectomy: a randomized trial

Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

“…40 Attempts were made to contact nine authors and none provided the requested data. [26][27][28]30,35,39,40,47,48 Reasons behind biases assessment are given in Table S2. 31,44 and one alfentanil.…”

“…35 All trials administered opioids before surgical incision. The administered dose ratio between lowand high-dose groups were respectively 1:15 in one trial, 27 between 1:8 and 1:6 in five trials, 29,34,37,41,52 between 1:5 and 1:2 in 18 trials 26,28,[31][32][33]35,36,[38][39][40]42,43,[46][47][48][49][50][51] and at a ratio of 1:1.5 in three trials. 30,44,45 Of note, one trial administered dose that are beyond what is commonly used in the clinical practice.…”

“…35 No trials injected long-acting opioids such as morphine or hydromorphone at the end of surgery. Over 60% (18 of 27) of the included trials used a volatile-based anaesthesia maintenance, [26][27][28][29][33][34][35][37][38][39][40][41][42]44,46,48,50 while the remaining trials administered propofol. [30][31][32]36,43,45,47,49,51,52 Regarding the types of surgery, authors included patients scheduled for gynaecological surgery in seven trials, [27][28][29][30]35,42,44 for abdominal surgery in nine trials, 33,34,[37][38][39]41,43,49,50 for cardiac surgery in four trials, 31,32,45,51 and finally, we combined the remaining seven tr...…”

Comment to: Pre-peritoneal local anaesthetic does not reduce post-operative pain in laparoscopic total extra-peritoneal inguinal hernia repair: double-blinded randomized controlled trial. Kulasegaran S, Rohan M, Pearless L, Hulme-Moir M

“…First, it is not clear if intraoperative analgesic administration was standardized using a specific criterion as this can alter the primary outcome [6]. Secondly, as fentanyl was used to treat postoperative pain, it is expected that patients were treated to keep low postoperative pain.…”

Pain outcomes and recovery after robotic laparoscopic transabdominal preperitoneal inguinal hernia repair

“…First, it is unclear if the authors standardized the intraoperative analgesic management for these patients as this can alter some of the studied outcomes [6]. Second, it is important to determine if he authors recruited the study patients consecutively or if the study results are vulnerable to selection bias.…”