Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta-analysis.

Preoperative administration of pharmacological substances, such as non-steroidal anti-inflammatory drugs or opioids, has been gaining acclaim as a preemptive measure to minimize postoperative pain. This systematic review and meta-analysis aimed at evaluating the effectiveness of this approach in adults undergoing surgical procedures. MEDLINE, EMBASE and the Cochrane Central Register were searched from inception through January 2015. Data from randomized placebo-controlled trials were screened, extracted and assessed for risk of bias according to The Cochrane Collaboration's Tool by two independent authors. The primary outcome measure was reduction in postoperative analgesic consumption during 24 h post surgery; effects were described as mean differences between the drug and placebo arms with corresponding 95% confidence intervals (CIs) and were pooled using random-effects models. Potential publication bias was tested using funnel plots and Egger's regression test for funnel plot asymmetry. Screened were 511 records, of which 39 were included in the final synthesis with data from 3172 patients. A significant reduction in postoperative analgesic consumption was observed using preoperative administration of non-steroidal anti-inflammatory drugs (NSAIDs; 95% CI, -0.61 to -0.14; 31 comparisons), chiefly by the COX-2 inhibitors class (95% CI, -0.95 to -0.33; 13 comparisons). Significant reduction was also observed for gabapentin (95% CI, -1.60 to -0.38; 6 comparisons). No significant effects were observed using opioids, propionic acids or oxicam derivatives. WHAT DOES THIS REVIEW ADD?: Current analyses endorse the effectiveness of COX-2 inhibitors and gabapentin in reducing acute postoperative pain when administered preemptively presurgery. Such corroboration is not found for opioids and other NSAID classes.

Are too many compression ultrasounds being performed for acute lower limb deep venous thrombosis in tertiary inpatients?

BACKGROUND: Venous thromboembolism (VTE) is a complex and serious condition, with high morbidity and mortality, especially in hospitalised patients. Yet its diagnosis remains challenging because of its unspecific clinical presentation. The objective of this study was to apply an algorithmic combination approach to diagnosing VTE by the addition of a D-dimer assay and Wells' criteria for our hospital's internal referral forms requesting compression ultrasound (CUS), to determine the effect on the number of referrals for CUS and the incidence of deep vein thrombosis (DVT) diagnoses. METHOD: Inpatients who had been referred to the hospital's vascular laboratory and who had undergone a CUS to exclude an acute lower limb DVT were retrospectively analysed between January 2009 and December 2013, and compared to prospectively collected data for the full year (2014) after the introduction of the new referral form. Comparisons included the mean annual number of referrals for CUS and the incidence of DVT diagnoses. RESULTS: The hospital incidence of diagnosed DVTs for 2009-2013 was 0.17%, compared to 0.16% for 2014 (ρ = 0.930). In contrast, the total number of referrals for CUS as a percentage of all hospital admissions dropped from 0.84% in 2009-2013 to 0.63% in 2014 (ρ = 0.009, odds ratio 0.76, 95% confidence interval: 0.62-0.93). CONCLUSION: The implementation of Wells' criteria and D-dimer to the new request form for CUS significantly decreased referrals to the hospital's vascular laboratory without impacting on the number of DVT cases diagnosed. This is a positive change which simplifies care and reduces the expense of ultrasonography investigations.