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Review
. 2025 Mar;134(3):621-626.
doi: 10.1016/j.bja.2024.11.004. Epub 2024 Nov 28.

A critical approach to research on perioperative pain management

Girish P Joshi  1 , Helene Beloeil  2 , Dileep N Lobo  3 , Esther M Pogatzki-Zahn  4 , Axel R Sauter  5 , Marc Van de Velde  6 , Christopher L Wu  7 , Henrik Kehlet  8 ; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy
Collaborators, Affiliations
Review

A critical approach to research on perioperative pain management

Girish P Joshi et al. Br J Anaesth. 2025 Mar.

Abstract

Optimal 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.

Keywords: analgesics; enhanced recovery after surgery; evidence base; perioperative pain; research; study design; trials.

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Figures

Fig 1
Fig 1
Six domains of healthcare quality based on data from the Institute of Medicine and the Agency for Healthcare and Research Quality.
See this image and copyright information in PMC

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