• Girish P Joshi, Helene Beloeil, Dileep N Lobo, Esther M Pogatzki-Zahn, Axel R Sauter, Marc Van de Velde, Christopher L Wu, Henrik Kehlet, and PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy.
• Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: girish.joshi@utsouthwestern.edu.
• Br J Anaesth. 2024 Nov 28.

AbstractOptimal postoperative pain management is a prerequisite for enhancing functional recovery after surgery. However, many studies assessing analgesic interventions have limitations. Consequently, further improvements in study design are urgently needed. In this focused editorial, we critically review prevalent trial designs and outcome measures including treatment-related adverse events evaluating analgesic interventions. Novel clinical trial designs should improve efficiency and enhance the likelihood of detecting relevant treatment effects. Cohort and database studies using propensity score matching and directed acyclic graphs could provide real-world generalisable information. Procedure-specific and patient-specific trials should allow identification of subpopulations most likely to benefit from a particular intervention after a specific surgical procedure and thus ascertain optimal analgesic strategies in challenging populations.Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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