Analgesia for emergency laparotomy: a systematic review

Area of Science:

• Anesthesiology
• Surgical Pain Management
• Evidence-Based Medicine

Background:

• Post-emergency laparotomy pain is inadequately controlled, leading to patient distress and complications.
• Effective pain management is crucial for rehabilitation and improving quality of life after major abdominal surgery.
• Pre-emptive analgesia strategies are commonly used in elective surgery but their role in emergency laparotomy is unclear.

Purpose of the Study:

• To systematically review and compare the efficacy of pre-emptive analgesia interventions for managing postoperative pain in adult emergency laparotomy patients.
• To identify and evaluate existing research on preoperative and intraoperative strategies aimed at reducing acute and chronic pain following emergency laparotomy.
• To inform clinical practice by assessing the evidence base for pre-emptive analgesia in this specific surgical context.

Main Methods:

• Comprehensive literature search across multiple databases (MEDLINE, Embase, PubMed, Web of Science, SCOPUS).
• Inclusion criteria focused on comparator studies of preoperative/intraoperative interventions for postoperative pain in adult emergency laparotomy.
• Exclusion of studies on non-abdominal surgery, postoperative sedation, non-formal pain assessment, and non-English manuscripts; dual screening of all eligible papers.

Main Results:

• Initial search identified 2389 papers; 1147 were screened after deduplication and handsearching.
• No eligible studies were identified that met the inclusion criteria for pre-emptive analgesia in emergency laparotomy.
• Many excluded studies pertained to elective or laparoscopic procedures, highlighting a gap in research for emergency laparotomy.

Conclusions:

• There is currently a lack of evidence supporting the use of pre-emptive analgesic strategies for emergency laparotomy.
• This contrasts with the established evidence base for elective surgical procedures.
• Potential reasons include variations in clinical practice, prioritization of physiological stabilization, and concerns regarding neuraxial techniques in emergency settings.