Summary of "Non-opioid analgesics for the prevention of chronic postsurgical pain: a systematic review and network meta-analysis"

Summary published August 8, 2023

Summary by Jayashree Sood, MD

British Journal of Anaesthesia | April 2023

Doleman B, Mathiesen O, Sutton AJ, Cooper NJ, Lund JN, Williams JP. Non-opioid analgesics for the prevention of chronic postsurgical pain: a systematic review and network meta-analysis. Br J Anaesth. 2023 Jun;130(6):719-728. doi: 10.1016/j.bja.2023.02.041. Epub 2023 Apr 12. PMID: 37059625; PMCID: PMC10251124.


  • A significant portion of patients (20-30%) undergoing surgery may experience ongoing pain after the procedure known as chronic post-surgical pain (CPSP), with some cases even leading to severe complications.
  • This study conducted a comprehensive analysis, or meta-analysis, to investigate the impact of non-opioid pain-relieving medications on both immediate pain control and the prevention of CPSP.
  • The research encompassed 134 trials involving 23,902 participants, focusing on randomized controlled trials (RCTs) that involved adults who had undergone various surgical procedures.
  • The interventions examined encompassed a range of non-opioid analgesics including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, ketamine, gabapentinoids (pregabalin/gabapentin), alpha-2 agonists (clonidine/dexmedetomidine), nefopam, intravenous lidocaine, and magnesium. These drugs are known to effectively alleviate acute postoperative pain, and they were administered through methods other than neuraxial administration.
  • The root causes of CPSP remain largely unclear, but they likely involve a combination of factors such as the intensity of acute pain, sustained peripheral inflammation, central sensitization, and heightened pain sensitivity. In line with the prevailing definition of CPSP (pain persisting for 3 months or more), the primary focus of the study was on the occurrence of CPSP within the first 6 months following surgery. Secondary outcomes included the utilization of opioids (within both the first 6 months and beyond) as well as the severity of opioid usage in these timeframes, along with the occurrence of serious adverse events.
  • After assessing efficacy, the analysis ranked intravenous (IV) lidocaine as the most effective, followed by ketamine, gabapentinoids, and dexmedetomidine in terms of reducing the incidence of CPSP six months after surgery.
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