Evidence map›Paper›PMID 28132136›Full record

ReviewCurrent pain and headache reports2017

Multimodal Analgesia, Current Concepts, and Acute Pain Considerations.

Erik M Helander, Bethany L Menard, Chris M Harmon, Ben K Homra, Alexander V Allain, Gregory J Bordelon, Melville Q Wyche, Ira W Padnos, Anna Lavrova, Alan D Kaye

Abstract readReview
PubMed Publisher
In one paragraph

Review in Current pain and headache reports, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 6 pooled it
12.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

78 citing papers in PubMed, 6 syntheses or guidelines pooled it, 211 citations in OpenAlex.

  1. Guideline
  2. Impact of erector spinae plane block on postoperative recovery quality in spinal surgery: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Guideline
  7. Trial
  8. Trial
  9. Trial
  10. Dexmedetomidine Pretreatment Confers Myocardial Protection and Reduces Mechanical Ventilation Duration for Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass.Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia · 2024
    Trial
  11. Trial
  12. Trial
  13. Effect of bilateral ultrasound-guided erector spinae plane block on postoperative pain after open lumbar spinal surgery: a double-blind, randomized controlled trial.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023
    Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Article
  19. Article
  20. Article

18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 2 institutions in 2 countries.

Erik M HelanderDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Bethany L MenardDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Chris M HarmonDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Ben K HomraUniversity of Queensland, Brisbane, Australia.
Alexander V AllainDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Gregory J BordelonDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Melville Q WycheDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Ira W PadnosDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Anna LavrovaDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA.
Alan D KayeDepartment of Anesthesiology, LSUHSC, New Orleans, LA, USA. akaye@lsuhsc.edu.
Louisiana State University Health Sciences Center New Orleans · USUniversity of Queensland · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purpose of reviewManagement of acute pain following surgery using a multimodal approach is recommended by the American Society of Anesthesiologists whenever possible. In addition to opioids, drugs with differing mechanisms of actions target pain pathways resulting in additive and/or synergistic effects. Some of these agents include alpha 2 agonists, NMDA receptor antagonists, gabapentinoids, dexamethasone, NSAIDs, acetaminophen, and duloxetine. RECENT

findingsAlpha 2 agonists have been shown to have opioid-sparing effects, but can cause hypotension and bradycardia and must be taken into consideration when administered. Acetaminophen is commonly used in a multimodal approach, with recent evidence lacking for the use of IV over oral formulations in patients able to take medications by mouth. Studies involving gabapentinoids have been mixed with some showing benefit; however, future large randomized controlled trials are needed. Ketamine is known to have powerful analgesic effects and, when combined with magnesium and other agents, may have a synergistic effect. Dexamethasone reduces postoperative nausea and vomiting and has been demonstrated to be an effective adjunct in multimodal analgesia. The serotonin-norepinephrine reuptake inhibitor, duloxetine, is a novel agent, but studies are limited and further evidence is needed. Overall, a multimodal analgesic approach should be used when treating postoperative pain, as it can potentially reduce side effects and provide the benefit of treating pain through different cellular pathways.

Indexed as

Drug Therapy, CombinationAcute PainAnalgesicsHumansPain ManagementPostoperative PainAnalgesicsAcetaminophenAlpha 2 agonistsClonidineDexamethasoneDexmedetomidineDuloxetineKetamineMagnesiumMultimodal analgesiaNSAIDsOpioids

Identifiers

PMID28132136
OpenAlexW2582210188

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.