The effect of analgesic technique on postoperative patient-reported outcomes including analgesia: a systematic review.
BACKGROUND
The effect of postoperative analgesia on patient-reported outcomes, such as quality of life, quality of recovery, and patient satisfaction, has not been systematically examined. These outcomes are assessed from the patient's perspective and are recognized as valid and important end-points in clinical medicine and research. We performed a systematic review to examine the effect of postoperative analgesia on patient-reported outcomes.


METHODS
The National Library of Medicine's Medline and the Cochrane Library databases were searched for the past decade (Jan, 1996 to Jun 1, 2006). Additional Medline searches for specific outcomes (i.e., satisfaction, quality of life, and quality of recovery) were also conducted.


RESULTS
Regional analgesic techniques provide statistically superior analgesia compared with systemic opioids. There are insufficient data to determine if the type of analgesic technique, degree of analgesia, and presence of side effects may influence quality of life, quality of recovery, satisfaction, and length of stay, due in part to some significant methodologic issues.


CONCLUSIONS
Although there are data suggesting that improved postoperative analgesia leads to better patient outcomes, there is insufficient evidence to support subsequent improvements inpatient-centered outcomes such as quality of life and quality of recovery. Modest reductions in pain scores do not necessarily equate to clinically meaningful improved pain relief for the patient. Further studies are needed to develop validated patient-reported instruments and to assess the effect of analgesic techniques on patient-reported outcomes in the perioperative period.
Liu
Spencer S
SS
Department of Anesthesiology, The Hospital of Special Surgery, and the Cornell Weill Medical Center, New York, New York, USA.
Wu
Christopher L
CL
D000082:Acetaminophen / Q000627:therapeutic use; D000588:Amines / Q000008:administration & dosage; D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D000077206:Gabapentin; D006305:Health Status Indicators; D006801:Humans; D036502:Infusions, Intralesional; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage; D009407:Nerve Block; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
D000588:Amines; D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D052246:Cyclooxygenase 2 Inhibitors; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D007649:Ketamine; D000077206:Gabapentin