A critical approach to research on perioperative pain management

Girish P Joshi; Helene Beloeil; Dileep N Lobo; Esther M Pogatzki-Zahn; Axel R Sauter; Marc Van de Velde; Christopher L Wu; Henrik Kehlet; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy

doi:10.1016/j.bja.2024.11.004

A critical approach to research on perioperative pain management

Br J Anaesth. 2024 Nov 28:S0007-0912(24)00661-5. doi: 10.1016/j.bja.2024.11.004. Online ahead of print.

Authors

Girish P Joshi¹, Helene Beloeil², Dileep N Lobo³, Esther M Pogatzki-Zahn⁴, Axel R Sauter⁵, Marc Van de Velde⁶, Christopher L Wu⁷, Henrik Kehlet⁸; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy

Collaborators

PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy:
Eric Albrecht, Helene Beloeil, Marie-Pierre Bonnet, Dario Bugada, Néel Desai, Geertrui Dewinter, Stephan M Freys, Girish P Joshi, Henrik Kehlet, Patricia Lavand'homme, Dileep N Lobo, Eleni Moka, Esther M Pogatzki-Zahn, Johan Raeder, Narinder Rawal, Axel R Sauter, Marc Van de Velde, Christopher L Wu

Affiliations

¹ Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: girish.joshi@utsouthwestern.edu.
² University of Rennes, CHU Rennes, Inserm, OSS 12142, CIC 1414, Anaesthesia and Intensive Care Department, Rennes, France.
³ Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.
⁵ Division of Emergencies and Critical Care, Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital, Oslo, Norway; Department of Anesthesia and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Department of Cardiovascular Sciences, KU Leuven and UZ Leuven, Leuven, Belgium.
⁷ Department of Anesthesiology, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
⁸ Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.

PMID: 39613529
DOI: 10.1016/j.bja.2024.11.004

Abstract

Optimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed. In this focused editorial, we critically review prevalent trial designs and outcome measures including treatment-related adverse events evaluating analgesic interventions. Novel clinical trial designs should improve efficiency and enhance the likelihood of detecting relevant treatment effects. Cohort and database studies using propensity score matching and directed acyclic graphs could provide real-world generalisable information. Procedure-specific and patient-specific trials should allow identification of subpopulations most likely to benefit from a particular intervention after a specific surgical procedure and thus ascertain optimal analgesic strategies in challenging populations.

Keywords: analgesics; enhanced recovery after surgery; evidence base; perioperative pain; research; study design; trials.

Publication types

Editorial