Evidence map›Paper›PMID 32696016›Full record

ArticleCritical care explorations2020

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis.

Kathleen E Wheeler, Ryan Grilli, John E Centofanti, Janet Martin, Celine Gelinas, Paul M Szumita, John W Devlin, Gerald Chanques, Waleed Alhazzani, Yoanna Skrobik and 8 more

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care explorations, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05825560 (Opioid-free Analgesia in Intensive Care Unit), which is not on this map. Cited by 25 papers.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed
2.9field-weighted citation impact, top 8% 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.

NCT05825560 phase4completednot on this mapstarted 2023, after this paper: background citation

Opioid-free Analgesia in Intensive Care Unit: a Prospective, Monocentric, Randomized, Double Blind, Feasability Clinical Trial

TypeinterventionalSponsorCentre Hospitalier Universitaire de NīmesRan2023 to 2026Enrolled50ConditionsIntubationArmsOFA multimodal analgesia, Standard multimodal analgesia
3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 47 citations in OpenAlex.

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  19. New Insights into the Comparative Effectiveness of Fentanyl and Morphine Infusions in ICU Patients.American journal of respiratory and critical care medicine · 2021
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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

18 authors at 8 institutions in 3 countries.

Kathleen E WheelerDepartment of Anesthesia, McMaster University, Hamilton, ON, Canada.
Ryan GrilliDivision of Critical Care, McMaster University, Hamilton, ON, Canada.
John E CentofantiDepartment of Anesthesia, McMaster University, Hamilton, ON, Canada.
Janet MartinDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Celine GelinasIngram School of Nursing, McGill University, Montreal, QC, Canada.
Paul M SzumitaDepartment of Pharmacy, Brigham and Women's Hospital, Boston, MA.
John W DevlinSchool of Pharmacy, Northeastern University, Boston, MA.
Gerald ChanquesDepartment of Anaesthesia and Intensive Care, University of Montpellier Saint Eloi Hospital, Montpellier, France.
Waleed AlhazzaniDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Yoanna SkrobikFaculty of Medicine, McGill University, Montreal, QC, Canada.
Michelle E KhoDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Mark E NunnallyDivision of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, NY.
Andre GagarineDepartment of Anesthesia, McMaster University, Hamilton, ON, Canada.
Begum A ErganDepartment of Pulmonary and Critical Care, Dokuz Eylul University, Izmir, Turkey.
Shannon FernandoUniversity of Ottawa, Ottawa, ON, Canada.
Carrie PriceWelch Medical Library, Johns Hopkins University, Baltimore, MD.
John LewinJohns Hopkins Medical Institutions, Baltimore, MD.
Bram RochwergDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
McMaster University · CAMcGill University · CABrigham and Women's Hospital · USImpact · CAInserm · FRJohns Hopkins University · USNortheastern University · USUniversity of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU. DATA SOURCES: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science. STUDY SELECTION: Two independent reviewers screened citations. Eligible studies included randomized controlled trials comparing efficacy and safety of an adjuvant-plus-opioid regimen to opioids alone in adult ICU patients. DATA EXTRACTION: We conducted duplicate screening of citations and data abstraction. DATA SYNTHESIS: Of 10,949 initial citations, we identified 34 eligible trials. These trials examined acetaminophen, carbamazepine, clonidine, dexmedetomidine, gabapentin, ketamine, magnesium sulfate, nefopam, nonsteroidal anti-inflammatory drugs (including diclofenac, indomethacin, and ketoprofen), pregabalin, and tramadol as adjunctive analgesics. Use of any adjuvant in addition to an opioid as compared to an opioid alone led to reductions in patient-reported pain scores at 24 hours (standard mean difference, -0.88; 95% CI, -1.29 to -0.47; low certainty) and decreased opioid consumption (in oral morphine equivalents over 24 hr; mean difference, 25.89 mg less; 95% CI, 19.97-31.81 mg less; low certainty). In terms of individual medications, reductions in opioid use were demonstrated with acetaminophen (mean difference, 36.17 mg less; 95% CI, 7.86-64.47 mg less; low certainty), carbamazepine (mean difference, 54.69 mg less; 95% CI, 40.39-to 68.99 mg less; moderate certainty), dexmedetomidine (mean difference, 10.21 mg less; 95% CI, 1.06-19.37 mg less; low certainty), ketamine (mean difference, 36.81 mg less; 95% CI, 27.32-46.30 mg less; low certainty), nefopam (mean difference, 70.89 mg less; 95% CI, 64.46-77.32 mg less; low certainty), nonsteroidal anti-inflammatory drugs (mean difference, 11.07 mg less; 95% CI, 2.7-19.44 mg less; low certainty), and tramadol (mean difference, 22.14 mg less; 95% CI, 6.67-37.61 mg less; moderate certainty).

conclusionsClinicians should consider using adjunct agents to limit opioid exposure and improve pain scores in critically ill patients.

Indexed as

acute painanalgesicscritical illnessmeta-analysisnonnarcoticopioidpain management

Identifiers

PMID32696016
PMCPMC7340332
OpenAlexW3041572802

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

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.