Non-Opioid Analgesics in Adults After Major Surgery : A Comprehensive Systematic Review
Abstract
Background: Postoperative pain management remains heavily reliant on opioids, despite risks of addiction, respiratory depression, and ileus. Non-opioid analgesics offer potential alternatives, but their comparative efficacy across major surgeries is unclear.
Methods: This comprehensive systematic review synthesized data from 80 randomized controlled trials, etc evaluating non-opioid analgesics in adults after major surgery. Interventions included NSAIDs, acetaminophen, IV lidocaine, dexamethasone, gabapentinoids, nefopam, regional techniques (epidural, TAP, QLB, paravertebral, EOIP blocks), multimodal protocols, and suzetrigine. Outcomes included pain intensity (VAS/NRS), opioid consumption (morphine equivalents), adverse effects, and recovery metrics.
Results: NSAIDs (IV/IM) consistently reduced pain and opioid use across cesarean, orthopedic, and abdominal surgeries (p<0.001), with etoricoxib reducing morphine by 31-34% (p<0.001) and IV ibuprofen reducing 24h morphine from 39.1mg to 29.8mg (p<0.001). Acetaminophen IV outperformed oral in spine surgery (66% lower morphine equivalents, p=0.001). IV lidocaine significantly accelerated gastrointestinal recovery (flatus reduced by ~6h, bowel movement by ~8h) and reduced opioid consumption by 35% (p<0.001). Dexamethasone reduced pain and opioids (MD -6.66mg morphine equivalents, p<0.001) and enhanced TAP block duration (PONV RR 0.40). Regional techniques: quadratus lumborum block reduced 24h morphine by ~24mg (p<0.01); erector…
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