• Kiyan Heybati, Fangwen Zhou, Matthew Joseph Lynn, Jiawen Deng, Saif Ali, Wenteng Hou, Shayan Heybati, Kosta Tzanis, Magnus Krever, Rafay Mughal, and Harish Ramakrishna.
• Mayo Clinic Alix School of Medicine, Mayo Clinic - Rochester, Rochester, MN.
• J. Cardiothorac. Vasc. Anesth. 2023 Jul 1; 37 (7): 116911781169-1178.

ObjectivesTo compare the relative efficacy of adjuvant nonopioid analgesic regimens in adult cardiac surgical patients.DesignThis frequentist, random-effects network meta-analysis (NMA) was prospectively registered on PROSPERO (CRD42021282913) and conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses for Network Meta-Analyses (PRISMA-NMA). The risk of bias (RoB) and confidence of evidence were assessed by RoB 2 and Confidence in Network Meta-Analysis, respectively. Relevant databases were searched from inception to October 9, 2021.SettingA total of 124 (N = 26,257) randomized controlled trials were included, of which 110 were analyzed.ParticipantsTrials enrolling adults (≥18 years of age) undergoing cardiac surgery that compared nonopioid analgesics against other nonopioid analgesics, placebo, or no additional treatment, as adjuvants to standard analgesic management, and reported at least 1 of the outcomes of interest.Measurement And Main ResultsOutcomes of interest included resting postoperative pain scores at 24 hours. Compared with standard care and/or placebo, pain scores were reduced significantly by 10 different regimens, including acetaminophen (N = 176; mean difference [MD] -0.66 points, 95% CI -1.16 to -0.15 points; high confidence), magnesium (N = 323; -0.05 points, 95% CI -0.07 to -0.02 points; high confidence), gabapentin (N = 96; MD -0.40 points, 95% CI -0.71 to -0.09; moderate confidence), and clonidine (N = 64; MD v0.38 points, 95% CI -0.73 to v0.04 points; moderate confidence). Indomethacin, diclofenac, magnesium, and gabapentin significantly reduced 24-hour opioid consumption. Four regimens significantly decreased the intensive care unit length of stay. Hydrocortisone, dexmedetomidine, and clonidine significantly decreased the duration of mechanical ventilation. Magnesium decreased, while methylprednisolone significantly increased, the risk of myocardial infarction.ConclusionsGiven the increasing emphasis on enhanced recovery after surgery(ERAS) protocols and the eventual goal of limiting opiate prescriptions postoperatively, the authors' data suggested far greater use of nonopioid adjuncts to minimize pain and enhance recovery following cardiac surgery.Copyright © 2023 Elsevier Inc. All rights reserved.

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