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Published in: Surgical Endoscopy 7/2007

01-07-2007 | Review

PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain

Authors: E. A. M. Neugebauer, R. C. Wilkinson, H. Kehlet, S. A. Schug, on behalf of the PROSPECT Working Group

Published in: Surgical Endoscopy | Issue 7/2007

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Abstract

Background

Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://​www.​postoppain.​org

Methods

The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT.

Results

To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy.

Conclusions

Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.
Literature
2.
go back to reference Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97:534–540PubMedCrossRef Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97:534–540PubMedCrossRef
3.
go back to reference Ashburn MA, Caplan MD, Carr DB, Connis RT, Ginsberg B, Green CR, Arbor A, Lema MJ, Nickinovich DG, J. RL (2004) Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 100:1573–1581 Ashburn MA, Caplan MD, Carr DB, Connis RT, Ginsberg B, Green CR, Arbor A, Lema MJ, Nickinovich DG, J. RL (2004) Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 100:1573–1581
4.
go back to reference Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86:598–612PubMedCrossRef Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86:598–612PubMedCrossRef
5.
go back to reference Bisgaard T (2006) Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 104:835–846PubMedCrossRef Bisgaard T (2006) Analgesic treatment after laparoscopic cholecystectomy: a critical assessment of the evidence. Anesthesiology 104:835–846PubMedCrossRef
9.
go back to reference Chia YY, Kuo MC, Liu K, Sun GC, Hsieh SW, Chow LH (2002) Does postoperative pain induce emesis? Clin J Pain 18:317–323PubMedCrossRef Chia YY, Kuo MC, Liu K, Sun GC, Hsieh SW, Chow LH (2002) Does postoperative pain induce emesis? Clin J Pain 18:317–323PubMedCrossRef
11.
go back to reference Coulling S (2005) Nurses’ and doctors’ knowledge of pain after surgery. Nurs Stand 19:41–49PubMed Coulling S (2005) Nurses’ and doctors’ knowledge of pain after surgery. Nurs Stand 19:41–49PubMed
12.
go back to reference Dalkey N, Helmer O (1963) An experimental application of the Delphi Method to the use of experts. Management Sci 9:458–467CrossRef Dalkey N, Helmer O (1963) An experimental application of the Delphi Method to the use of experts. Management Sci 9:458–467CrossRef
13.
go back to reference Delbecq AL, VandeVen AH (1971) A Group Process Model for Problem Identification and Program Planning. J Appl Behav Sci VII:466–491CrossRef Delbecq AL, VandeVen AH (1971) A Group Process Model for Problem Identification and Program Planning. J Appl Behav Sci VII:466–491CrossRef
14.
go back to reference Fischer HBJ, Simanski CJP (2005) A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 60:1189–1202PubMedCrossRef Fischer HBJ, Simanski CJP (2005) A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 60:1189–1202PubMedCrossRef
15.
go back to reference Gray A, Kehlet H, Bonnet F, Rawal N (2005) Predicting postoperative analgesia outcomes: NNT league tables or procedure-specific evidence? Br J Anaesth 94:710–714PubMedCrossRef Gray A, Kehlet H, Bonnet F, Rawal N (2005) Predicting postoperative analgesia outcomes: NNT league tables or procedure-specific evidence? Br J Anaesth 94:710–714PubMedCrossRef
16.
go back to reference Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–1322PubMedCrossRef Grimshaw JM, Russell IT (1993) Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 342:1317–1322PubMedCrossRef
17.
go back to reference Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323:334–336PubMedCrossRef Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323:334–336PubMedCrossRef
19.
go back to reference Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRef
20.
go back to reference Kehlet H (2005) Procedure-specific postoperative pain management. Anesthesiol Clin North America 23:203–210PubMedCrossRef Kehlet H (2005) Procedure-specific postoperative pain management. Anesthesiol Clin North America 23:203–210PubMedCrossRef
21.
go back to reference Kehlet H, Buchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54PubMedCrossRef Kehlet H, Buchler MW, Beart RW Jr, Billingham RP, Williamson R (2006) Care after colonic operation—is it evidence-based? Results from a multinational survey in Europe and the United States. J Am Coll Surg 202:45–54PubMedCrossRef
22.
go back to reference Kehlet H, Gray AW, Bonnet F, Camu F, Fischer HB, McCloy RF, Neugebauer EA, Puig MM, Rawal N, Simanski CJ (2005) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 19:1396–1415PubMedCrossRef Kehlet H, Gray AW, Bonnet F, Camu F, Fischer HB, McCloy RF, Neugebauer EA, Puig MM, Rawal N, Simanski CJ (2005) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following laparoscopic cholecystectomy. Surg Endosc 19:1396–1415PubMedCrossRef
23.
go back to reference Kunz R, Oxman AD (1998) The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials. BMJ 317:1185–1190PubMed Kunz R, Oxman AD (1998) The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials. BMJ 317:1185–1190PubMed
24.
go back to reference Laska EM, Sunshine A, Wanderling JA, Meisner MJ (1982) Quantitative differences in aspirin analgesia in three models of clinical pain. J Clin Pharmacol 22:531–542PubMedCrossRef Laska EM, Sunshine A, Wanderling JA, Meisner MJ (1982) Quantitative differences in aspirin analgesia in three models of clinical pain. J Clin Pharmacol 22:531–542PubMedCrossRef
25.
go back to reference Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, Feinglass NG, Metzger PP, Fulmer JT, Smith SL (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 83:757–765PubMedCrossRef Liu SS, Carpenter RL, Mackey DC, Thirlby RC, Rupp SM, Shine TS, Feinglass NG, Metzger PP, Fulmer JT, Smith SL (1995) Effects of perioperative analgesic technique on rate of recovery after colon surgery. Anesthesiology 83:757–765PubMedCrossRef
26.
go back to reference Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194PubMedCrossRef Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194PubMedCrossRef
27.
go back to reference Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi C, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16:1121–1143PubMedCrossRef Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi C, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16:1121–1143PubMedCrossRef
28.
go back to reference Neugebauer E, Schug S (2006) Procedure-specific postoperative pain management (PROSPECT) recommendations: a rigorous methodology to minimise bias. Eur J Anaesthesiol Suppl 23:6 Neugebauer E, Schug S (2006) Procedure-specific postoperative pain management (PROSPECT) recommendations: a rigorous methodology to minimise bias. Eur J Anaesthesiol Suppl 23:6
29.
go back to reference Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP (2002) Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 95:627–634PubMedCrossRef Pavlin DJ, Chen C, Penaloza DA, Polissar NL, Buckley FP (2002) Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg 95:627–634PubMedCrossRef
30.
go back to reference Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93:1123–1133PubMedCrossRef Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93:1123–1133PubMedCrossRef
31.
go back to reference Philip BK, Reese PR, Burch SP (2002) The economic impact of opioids on postoperative pain management. J Clin Anesth 14:354–364PubMedCrossRef Philip BK, Reese PR, Burch SP (2002) The economic impact of opioids on postoperative pain management. J Clin Anesth 14:354–364PubMedCrossRef
34.
go back to reference Wu CL, Naqibuddin M, Rowlingson AJ, Lietman SA, Jermyn RM, Fleisher LA (2003) The effect of pain on health-related quality of life in the immediate postoperative period. Anesth Analg 97:1078–1085PubMedCrossRef Wu CL, Naqibuddin M, Rowlingson AJ, Lietman SA, Jermyn RM, Fleisher LA (2003) The effect of pain on health-related quality of life in the immediate postoperative period. Anesth Analg 97:1078–1085PubMedCrossRef
Metadata
Title
PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain
Authors
E. A. M. Neugebauer
R. C. Wilkinson
H. Kehlet
S. A. Schug
on behalf of the PROSPECT Working Group
Publication date
01-07-2007
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 7/2007
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-006-9186-4

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