The Impact of Opioid-Sparing Analgesia on Postoperative Pain and Recovery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Zhen Zhang, Jingjing Wang, Zhiguang Ping, Xiaogao Jin, Jianjun Yang, Wang Yan, Qinjun Chu, Pain Group of the Chinese Society of Anesthesiology, Yingying Zhao, Yi Feng, Wenjun Yan
Abstract
INTRODUCTION: Opioids are commonly used for postoperative pain management but are associated with adverse effects and risk of dependence, potentially hindering recovery. This systematic review evaluates the impact of opioid-sparing analgesic strategies on postoperative pain and functional recovery to provide evidence-based guidance for clinical practice and future research. METHODS: A comprehensive systematic review and meta-analysis was conducted by searching PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials on adult surgical patients from the inception of each database to July 10, 2024. The primary outcome was the total morphine consumption within 24 h postoperatively. Secondary outcomes included postoperative pain scores at 24 h, patient satisfaction, length of stay, quality of recovery, and opioid-related adverse effects, such as postoperative nausea and vomiting (PONV), sedation, dizziness, drowsiness, pruritus, urinary retention, and hypotension. RESULTS: A total of 58 studies (5614 patients) were included. The total morphine consumption was reduced, with a mean difference (MD) of -9.47, 95% confidence interval (95% CI) [-13, -5.95]. The postoperative pain score at 24 h was lower than in the control group, with an MD of -0.72 (95% CI [-0.97, -0.47]). Patient satisfaction was higher than in the control group, with an MD of 0.88 (95% CI [0.36, 1.40]). There were no significant differences in length of stay or recovery quality compared to the control group (P = 0.7, P = 0.48). The incidence of PONV was lower than the control group, with an odds ratio (OR) of 0.73 (95% CI [0.59, 0.90]), and the incidence of pruritus was also lower than in the control group, with an OR of 0.64 (95% CI [0.41, 0.98]). There were no differences in other adverse reactions compared to the control group. CONCLUSION: The results of this meta-analysis indicate that, compared to opioid-based analgesia, opioid-sparing analgesia is associated with reduced morphine consumption within 24 h postoperatively, lower pain scores, and a decreased incidence of PONV and pruritus. Patient satisfaction was also improved. The findings will help clinicians make evidence-based decisions for postoperative pain management. TRIAL REGISTRATION: The protocol for this meta-analysis: PROSPERO CRD42024579882.