• Michael Verret, Nhat H Lam, Manoj Lalu, Stuart G Nicholls, Alexis F Turgeon, Daniel I McIsaac, Myriam Hamtiaux, John Bao Phuc Le, Ian Gilron, Lucy Yang, Mahrukh Kaimkhani, Alexandre Assi, David El-Adem, Makenna Timm, Peter Tai, Joelle Amir, Sriyathavan Srichandramohan, Abdulaziz Al-Mazidi, Nicholas A Fergusson, Brian Hutton, Fiona Zivkovic, Megan Graham, Maxime Lê, Allison Geist, Mélanie Bérubé, Patricia Poulin, Risa Shorr, Helena Daudt, Guillaume Martel, Jason McVicar, Husein Moloo, Dean A Fergusson, and Perioperative Anesthesia Clinical Trials (PACT) group.
• Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, Civic Campus, The Ottawa Hospital, Ottawa, ON, Canada; Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada. Electronic address: mverr051@uottawa.ca.
• Br J Anaesth. 2024 Apr 1; 132 (4): 758770758-770.

BackgroundPostoperative patient-centred outcome measures are essential to capture the patient's experience after surgery. Although a large number of pharmacologic opioid minimisation strategies (i.e. opioid alternatives) are used for patients undergoing surgery, it remains unclear which strategies are most promising in terms of patient-centred outcome improvements. This scoping review had two main objectives: (1) to map and describe evidence from clinical trials assessing the patient-centred effectiveness of pharmacologic intraoperative opioid minimisation strategies in adult surgical patients, and (2) to identify promising pharmacologic opioid minimisation strategies.MethodsWe searched MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases from inception to February 2023. We included trials investigating the use of opioid minimisation strategies in adult surgical patients and reporting at least one patient-centred outcome. Study screening and data extraction were conducted independently by at least two reviewers.ResultsOf 24,842 citations screened for eligibility, 2803 trials assessed the effectiveness of intraoperative opioid minimisation strategies. Of these, 457 trials (67,060 participants) met eligibility criteria, reporting at least one patient-centred outcome. In the 107 trials that included a patient-centred primary outcome, patient wellbeing was the most frequently used domain (55 trials). Based on aggregate findings, dexmedetomidine, systemic lidocaine, and COX-2 inhibitors were promising strategies, while paracetamol, ketamine, and gabapentinoids were less promising. Almost half of the trials (253 trials) did not report a protocol or registration number.ConclusionsResearchers should prioritise and include patient-centred outcomes in the assessment of opioid minimisation strategy effectiveness. We identified three potentially promising pharmacologic intraoperative opioid minimisation strategies that should be further assessed through systematic reviews and multicentre trials. Findings from our scoping review may be influenced by selective outcome reporting bias.Study RegistrationOSF - https://osf.io/7kea3.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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