Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Afshan, Gauhar; Khan, Robyna Irshad; Ahmed, Aliya; Siddiqui, Ali Sarfraz; Rehman, Azhar; Raza, Syed Amir; Kerai, Rozina; Mustafa, Khawaja

doi:10.1186/s12871-021-01375-w

Table 1 Characteristics of the published randomized controlled trails presented with respect to type of surgery

From: Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Authors	Country	Age Range	Gender	N	Groups	N	Modalities Studied	Pain Assessment Tool	Modalities used	Duration of post-operative Pain studied	Rescue Analgesia
Bhatia et al., (2014) [12]	India	18–60	Both	60	3	20	Ultrasound-guided posterior transversus abdominis plane (TAP) block with 15 mL of 0.375% ropivacaine	VAS (Visual Analogue Scale)	Single	24 h	Tramadol
						20	Ultrasound-guided subcostal TAP block with 15 mL of 0.375% ropivacaine
						20	Control
Shukla et al.,(2015) [13]	India	18–60	Both	120	3	40	Intraperitoneal bupivacaine 50 ml 0.25% + 5 ml Normal saline	VAS	Single	24 h	Diclofenac
						40	Bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS)
						40	Bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS)
Sinha et al., (2016) [14]	India	18–65	Both	60	2	30	TAP block with 0.25% Bupivacaine	VAS	Single	24 h	Diclofenac
Sinha et al., (2016) [14]						30	TAP block with 0.375% Ropivacaine
Kamhawy et al., (2017) [15]	Egypt	21–60	Both	46	2	23	Unilateral subcostal TAP block	VAS	Multi	24 h	PCA Morphine
Kamhawy et al., (2017) [15]						23	Unilateral thoracic paravertebral block
Saxena et al., (2016) [16]	India	18–70	Both	80	2	40	Local anesthetic infiltration of surgical incision	NRS (Numerical rating score)	Multi	24 h	Fentanyl
Saxena et al., (2016) [16]						40	Bilateral rectus sheath and right TAP blocks
Ali et al., (2012) [17]	Pakistan	35–65	Both	60	2	30	Oral pregablin 150 mg	VAS	Single	24 h	Nalbuphine
Ali et al., (2012) [17]						30	Oral celecoxib 200 mg
Suseela et al., (2018) [18]	India	20–65	Both	80	2	40	Bilateral ultrasound-guided subcostal TAP block with 20 mL of 0.25% bupivacaine	NRS	Multi	24 h	Tramadol Diclofenac
Suseela et al., (2018) [18]						40	Port-site infiltration with 20 mL of 0.5% bupivacaine
Anand et al.,(2017) [19]	India	20–60	Both	60	2	30	Alprazolam	VAS	Multi	24 h	Tramadol
Anand et al.,(2017) [19]						30	Pregabalin
Pasha et al., (2018) [20]	Nowshera	18–65	Both	90	2	45	Gabapentin	VAS	Multi	24 h	None
Pasha et al., (2018) [20]						45	Placebo
Khan et al., (2018) [21]	pakistan	18–60	Both	126	2	63	Posterior TAP block with 0.375% bupivacaine	NRS	Multi	24 h	Tramadol
Khan et al., (2018) [21]						63	subcostal TAP block with 0.375% bupivacaine
Jain et al., (2018) [22]	India	20–60	Both	60	2	30	Intraperitoneal Saline with 500 ml	NRS	single	24 h	Tramadol
Jain et al., (2018) [22]						30	Intraperitoneal Bupivacaine with 20 ml of 0.5% (100 mg)
Amr et al., (2010) [23]	Egypt	18+	Both	40	2	20	Preincisional thoracic epidural analgesia (TEA)	VAS	Single	24 h	None
Amr et al., (2010) [23]						20	End of surgery TEA
Khalil et al., (2017) [24]	Egypt	20–60	Both	40	2	20	Ultrasound-guided serratus anterior plane block	VAS	Multi	24 h	Morphine
Khalil et al., (2017) [24]						20	TEA
Dutta et al., (2017) [25]	India	18–70	Both	30	2	15	Bolus of 15 mL of 0.75% ropivacaine over 3 to 5 min, followed by an infusion of 0.2% ropivacaine at 0.1 ml/kg/hour	VAS	Multi	24 h	Morphine
Dutta et al., (2017) [25]						15	15 ml of 0.75% ropivacaine plus dexmedetomidine,1 mg/kg bolus over 3 to 5 minutesfollowed by an infusion of 0.2% ropivacaine plus 0.2 mg/kg/hour of dexmedetomidine at 0.1 ml/kg/hour.
Biswas et al., (2016) [26]	India	18–60	Both	60	2	30	Epidural: 7.5 ml bolus of 0.125% Bupivacaine with 50 μg Fentanyl	VAS/ FPORS	Muti	24 h	Tramadol
Biswas et al., (2016) [26]						30	Paravertebral 15 ml bolus of 0.125% Bupivacaine with 50 μg Fentanyl
Bakshi et al., (2016) [27]	India	18–75	Female	71	2	36	Rectus sheath block with 0.25% bupivacaine	NRS	Multi	48 h	Morphine
Bakshi et al., (2016) [27]						35	Rectus sheath block with normal saline
Dhanapal et al., (2014) [28]	India	18+	Both	94	2	47	Wound infusion with Bupivacaine	VAS	Single	48 h	Morphine
Dhanapal et al., (2014) [28]						47	Wound infusion with N saline
Wahba et al., (2014) [29]	Egypt	59–75	Both	44	2	22	Thoracic epidural infusion	VRS	Multi	48 h	Morphine (PCA)
Wahba et al., (2014) [29]						22	Bilateral TAP block infusion with catheter
Sethi et al., (2014) [30]	India	18–45	Both	100	2	50	Patient controlled epidural analgesia (PCEA) with Ketamine + Morphine	VAS	Multiple	48 h	Diclofenac
Sethi et al., (2014) [30]						50	PCEA Morphine
Moawad et al., (2014) [31]	Egypt	20–60	Both	100	2	50	PCEA Bupivacaine + Fentanyl	NRS	Multiple	24 h	Fentanyl
Moawad et al., (2014) [31]						50	Intravenous patient controlled analgesia (PCA) with Fentanyl
Patil et al., (2018) [32]	India	18–65	Female	60	2	30	Thoracic epidural infusion with 0.125% Ropivacaine and Fentanyl 0.125% Bupivacaine and Fentanyl	VAS	Multi	24 h	Tramadol
Patil et al., (2018) [32]						30
Bharti et al., (2018) [33]	India	Adult patients	Both	40	2	20	50 μg Dexmedetomidine with 10 ml of 0.125% Bupivacaine in thoracic epidural	VAS	Multi	24 h	Diclofenac
Bharti et al., (2018) [33]						20	50 μg Fentanyl with 10 ml 0.125% Bupivacaine in thoracic epidural
Alvi et al., (2017) [34]	Pakistan	18–50	Both	200	2	100	TAP block	NRS	Single	24 h	None
Alvi et al., (2017) [34]						100	Placebo block
Patel et al., (2018) [35]	India	20 to 65	Both	60	2	30	TAP block with Ropivacaine (0.5%) 20 ml	VAS	Multi	24 h	Diclofenac
Patel et al., (2018) [35]						30	Spinal anaesthesia
Mishra et al., (2018) [36]	India	18–60	Both	60	2	30	Thoracic paravertebral block (20 mL 0.25% bupivacaine)	VAS	Multi	24 h	Tramadol
Mishra et al., (2018) [36]						30	IV PCA with fentanyl
Bharti et al., (2011) [37]	India	18–60	Both	40	2	20	TAP Block with 20 mL of 0.25% bupivacaine	VAS	Single	24 h	Morphine
Bharti et al., (2011) [37]						20	TAP Block with Saline
Chotton et al., (2014) [38]	India	18–60	Female	90	2	45	Pregabalin 150 mg	VAS	Multi	24 h	Ketorolac
Chotton et al., (2014) [38]						45	Placebo
Badawy et al., (2015) [39]	Egypt	40–70	Female	60	3	20 20 20	Oral gabapentin 800 mg Gabapentin 800 mg + Dexamethasone 8 mg Placebo	VAS	Multi	24 h	Meperidine
Bashandy et al., (2015) [40]	Egypt	Adult	Female	120	2	60 60	Ultrasound-guided Pecs block Control	VAS	Single	24 h	Morphine
Hetta et al., (2016) [41]	Egypt	Adult	Female	111	4	28 27 26 30	Pregabalin 75 mg Pregabalin 150 mg Pregabalin 300 mg Placebo Capsule	VAS	Single	24 h	Morphine
Kasimahanti et al.,(2016) [42]	India	18–60	Female	58	2	28 30	Single-level, unilateral ultrasound-guided TPVB at T4 level using 0.3 mL/kg of 0.5% ropivacaine Double-level, unilateral ultrasound-guided TPVB at T2 and T5 level using a total volume of 0.3 mL/kg of 0.5% ropivacaine	NRS	Single	24 h	Diclofenac
Kulhari et al., (2016) [43]	India	18–65	Female	40	2	20	TPVB with ropivacaine 0.5%, 25 ml,	VAS	Single	24 h	Morphine
Kulhari et al., (2016) [43]						20	PECS II block with ropivacaine 0.5%
Gupta et al., (2017) [44]	India	18–65	Female	50	2	25	Paravertebral block	VAS	Multi	72 h	PCA Morphine
Gupta et al., (2017) [44]						25	Serratus Plane block
Bhuvaneswari et al.,(2012) [45]	India	Adult	Female	48	4	12	Paravertebral block with 0.25% bupivacaine with epinephrine 5 mcg/ ml	VAS	Single	24 h	Morphine
						12	Paravertebral block with 0.25% bupivacaine + epinephrine 5 mcg/ml with 2 mcg/ml fentanyl
						12	Paravertebral block with 0.5% bupivacaine + epinephrine 5 mcg/ml or isotonic saline
						12	Noraml Salin
Mahran et al., (2015) [46]	Egypt	18–65	Female	90	3	30	Pregabalin 150 mg oral	VAS	Multi	24 h	Morphine
						30	Placebo capsule (oral) and 0.5 mg/kg ketamine IV
						30	Placebo
Kundra et al., (2013) [47]	India	Adult	Female	120	2	60	Paravertebral block	VAS	Multi	24 h	No rescue analgesia
Kundra et al., (2013) [47]						60	Interpleural block
M. Neetu et al., (2018) [48]	India	18–70	Female	60	2	30	PECS block	VAS	Multi	24 h	None
M. Neetu et al., (2018) [48]						30	Placebo
Mukherjee et al., (2018) [49]	India	35–60	female	88	2	44	Ropivacaine (0.5%)	VAS	single	48 h	Diclofenac
Mukherjee et al., (2018) [49]						44	Dexmedetomidine 1 μ/kg
Megha et al., (2018) [50]	India	18–60	Female	47	2	23	Paravertebral block with 20 ml bupivacaine 0.25% with morphine 3 mg	NRS	Multi	24 h	Diclofenac
Megha et al., (2018) [50]						24	Dexmedetomidine 1 μg/kg
Manzoor et al., (2018) [51]	India	18–70	Female	60	2	30	PECS I block with 30 ml 0.25% bupivacaine	VAS	single	24 h	Diclofenac
Manzoor et al., (2018) [51]						30	PECS I block with 10 ml 0.25% bupivacaine with dexmedetomidine
Kumar et al., (2018) [52]	India	?	Female	50	2	25	Opioids and non-steroidal anti-inflammatory drug	VAS	Multi	24 h	Tramadol
Kumar et al., (2018) [52]						25	PECS I with 0.25% bupivacaine
Bharti et al., (2015) [53]	India	20–60	Both	54	2	27	Supraclavicular block with 1 μg/kg of Dexmedetomidine along with equal volumes of 0.75% ropivacaine and 2% lidocaine with adrenaline.	VAS	Single	24 h	Tramadol Diclofenac
Bharti et al., (2015) [53]						27	0.75% Ropivacaine and 2% Lidocaine with adrenaline (1:2,00,000)
Kumar et al., (2014) [54]	India	18–60	Both	30	2	15	Ultrasound-guided stellate ganglion block with 2% Lidocaine	VAS	Single	24 h	PCIA Used [No Rescue]
Kumar et al., (2014) [54]						15	Ultrasound-guided stellate ganglion block with 0.9% Saline
Mullaji et al., (2010) [55]	India	50–80	Both	40	2	20	Combined spinal epidural + local anesthetic infiltration	VAS	Single	24 h	None
Mullaji et al., (2010) [55]						20	Combined spinal epidural with no local anesthetic infiltration
Khanna et al., (2017) [56]	India	40–60	Both	90	3	30	Epidural with ropivacaine 0.1%	VAS	Multi	36 h	PCEA
						30	Epidural with ropivacaine 0.1% with fentanyl 2.5μg/mL
						30	Epidural with ropivacaine 0.0625% with fentanyl 2.5μg/mL
Anis et al., (2011) [57]	Egypt	18–60	Both	60	3	20	Lumbar plexus block with 15 ml bupivacaine 0.25% + clonidine	VAS	Single	24 h	Morphine
						20	Lumbar plexus block with bupivacaine 0.25% + clonidine
						20	No Block
Sawhney et al., (2015) [58]	India	Adult	Both	100	4	25	Epidural with 0.2% Ropivacaine	VAS	Single	24 h	Tramadol
						25	Epidural with0.1% Ropivacaine+Fentanyl 2 μg/ml
						25	Epidural with 0.2% Bupivacaine
						25	Epidural with Bupivacaine 0.1% with Fentanyl 2 μg/ml.
Trabelsi et al., (2017) [59]	Tunisia	> 18	Both	60	2	30	Suprascapular block + supraclavicular block	VAS	Multi	24 h	Morphine
Trabelsi et al., (2017) [59]						30	Interscalene block
Meghana et al., (2017) [60]	India	20–65	Both	70	2	35	0.125% bupivacaine and 2 mg/ml fentanyl epidural infusion	NRS	Single	48 h	Tramadol
Meghana et al., (2017) [60]						35	0.2% ropivacaine and 2 mg/ml fentanyl as epidural infusion
Thakur et al., (2015) [61]	India	18–60	Both	67	3	22	Axillary brachial plexus block with bupivacine, lignocaine, adrenaline and buprenorphine + IM placebo	VAS	Single	24 h	Diclofenac
						23	Axillary brachial plexus block with bupivacine, lignocaine, adrenaline and placebo + IM buprenorphine
						22	Axillary brachial plexus block with bupivacine, lignocaine, adrenaline and placebo + IM placebo
Mostafa et al., (2018) [62]	Egypt	50–70	Both	60	2	30	Levobupivacaine 0.125%	VAS	Multi	24 h	None
Mostafa et al., (2018) [62]						30	IV fentanyl 20 μg/ml

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