BACKGROUND Managing postoperative pain in patients with obesity is challenging. Although multimodal analgesia has proved effective for pain relief, the specific impacts of different nonopioid i.v. analgesics and adjuvants on these patients are not well-defined. This study aims to assess the effectiveness of nonsteroidal antiinflammatory drugs, paracetamol, ketamine, α-2 adrenergic receptor agonists, lidocaine, magnesium, and oral gabapentinoids in reducing perioperative opioid consumption and, secondarily, in mitigating the occurrence of general and postoperative pulmonary complications (POPCs), nausea, vomiting, PACU length of stay (LOS), and hospital LOS among surgical patients with obesity. METHODS A systematic review and network meta-analysis was performed. PubMed, Scopus, Web of Science, CINAHL, and EMBASE were searched. Only English-language RCTs investigating the use of nonopioid analgesics and adjuvants in adult surgical patients with obesity were included. The quality of evidence and certainty were assessed using the RoB 2 tool and GRADE framework, respectively. RESULTS In total, 37 RCTs involving 3602 patients were included in the quantitative analysis. Compared with placebo/no intervention or a comparator, dexmedetomidine, ketamine, lidocaine, magnesium, and gabapentin significantly reduced postoperative opioid consumption after surgery. Ketamine/esketamine also significantly reduced POPCs. Ibuprofen, dexmedetomidine, and lidocaine significantly reduced postoperative nausea, whereas dexmedetomidine, either alone or combined with pregabalin, and lidocaine reduced postoperative vomiting. Dexmedetomidine significantly reduced PACU LOS, whereas both paracetamol and lidocaine reduced hospital LOS. CONCLUSIONS Intravenous nonopioid analgesics and adjuvants are crucial in multimodal anaesthesia, reducing opioid consumption and enhancing postoperative care in adult surgical patients with obesity. SYSTEMATIC REVIEW PROTOCOL CRD42023399373 (PROSPERO).

中文翻译：

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非阿片类镇痛药和佐剂在多模式镇痛中减少术后阿片类药物消耗和肥胖并发症的疗效：系统评价和网络荟萃分析。


背景 管理肥胖患者的术后疼痛具有挑战性。尽管多模式镇痛已被证明对缓解疼痛有效，但不同的非阿片类静脉注射镇痛药和辅助剂对这些患者的具体影响尚不明确。本研究旨在评估非甾体抗炎药、扑热息痛、氯胺酮、α-2 肾上腺素能受体激动剂、利多卡因、镁和口服加巴喷丁类药物在减少围手术期阿片类药物消耗方面的有效性，其次，在减轻一般和术后肺部并发症 （POPC） 、恶心、呕吐、PACU 住院时间 （LOS） 和住院 LOS 的发生肥胖手术患者。方法 进行系统评价和网状荟萃分析。检索了 PubMed、Scopus、Web of Science、CINAHL 和 EMBASE。仅纳入调查非阿片类镇痛药和辅助剂在成年肥胖手术患者中使用的英语 RCT。分别使用 RoB 2 工具和 GRADE 框架评估证据质量和质量。结果 定量分析共纳入 37 项 RCT，涉及 3602 例患者。与安慰剂/无干预或对照相比，右美托咪定、氯胺酮、利多卡因、镁和加巴喷丁显着减少了术后阿片类药物的消耗。氯胺酮/艾氯胺酮也显著降低了 POPC。布洛芬、右美托咪定和利多卡因可显著减轻术后恶心，而右美托咪定单独使用或与普瑞巴林联合使用和利多卡因可减轻术后呕吐。右美托咪定可显著降低 PACU LOS，而扑热息痛和利多卡因均可降低医院 LOS。 结论静脉注射非阿片类镇痛药和辅助剂在多模式麻醉中至关重要，减少阿片类药物的消耗并加强成年肥胖手术患者的术后护理。系统评价方案 CRD42023399373 （PROSPERO）。