Postoperative pain management modalities used for adult patients in LMIC – A systematic review of randomized controlled trials

Document Type



Anaesthesia; Libraries


Background: Unrelieved postoperative pain afflicts millions each year in LMIC. Despite substantial advances in the study of pain, this area remains neglected. Anesthesia and related specialties have been reporting the enormity of the burden of pain and suffering in LMIC citing disproportionately limited resources, lack of regulations, and paucity of pain education as main reasons Current systematic review was designed to the ascertain the types of modalities studied over the last decade in the LMIC for possible use in the management of postoperative pain in adult patients.
Methodology: A comprehensive search was performed in December 2018 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant studies on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. After inclusion/exclusion criteria were ap[1]plied. 51 studies were included,
Results: 11 trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional anesthesia. Different analgesic modalities were studied in four trials on thoracotomy but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In two trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopedic surgery, multimodal analgesia was used with some form of regional analgesia.
Conclusion: Postoperative pain is managed by multimodal approach following common surgical procedures in LMIC. Some form of regional analgesia is frequently used. Though the small snapshot reflects practices according to the current guidelines, these results should be interpreted cautiously as majority of studies are small and heterogeneous.

Publication (Name of Journal)

Anesthesia & Analgesia