Reducing opioid consumption levels post-operatively following gastrointestinal surgery - A systematic review of randomized trials

Background: The opioid crisis has reached epidemic proportions worldwide. Unfortunately, prescription of opioid analgesia in the post-operative phase of treatment is contributing to this problem. We aimed to perform a systematic review of randomized controlled trials to establish methods of reducing opioid toxicity following gastrointestinal surgery. Materials and methods: A systematic review was performed in accordance to the PRISMA guidelines. Randomized controlled trials were included. The risk of bias 2.0 assessment was used to determine potential bias. Results: In total, 14 prospective, randomized trials involving 1,687 patients (mean age: 50 years (range: 21-80) were included in this systematic review. Overall, 42.9% of trials reported outcomes in relation to intravenous infusion of analgesia and their impact on opioid consumption at discharge (6/14), 5 trials of which reported reduced consumptions levels (5/6, 83.3%). Overall, 28.6% of studies assessed the role of oral medications reducing the requirement for opioids post-operatively (4/14), of which, just one trial reported a significant effect of oral vitamin C supplementation compared to placebo. Overall, just one trial outlined the impact of the use of patient-controlled analgesia, ultrasound-guided nerve blocks, intramuscular anti-inflammatory gels, and the role of opioid-specific counselling in reducing opioid consumption post-operatively. Conclusion: This systematic review adds further data to the surgical literature regarding efficacious methods to tackle the 'opioid crisis'. Among the most promising avenues are opioid-specific counselling and peri-operative prescription of intravenous infusions to counteract the increasing opioid consumption, which directly contributes to the 'opioid epidemic' for citizens across the world.