Racial and ethnic differences in acute post-operative pain management: Systematic review and meta-analysis

Abstract

Background: There are significant racial and ethnic differences in healthcare outcomes, including pain treatment.

Objectives: We conducted a systematic review and meta-analysis to investigate the racial and ethnic differences in acute pain treatment of surgical patients.

Methods: We searched PubMed, Embase, and Scopus databases for any studies that reported racial and ethnic minority groups and treating acute postoperative pain. Random-effect meta-analysis was used to compare the odds ratio of receipt of regional anesthesia among racial and ethnic groups.

Results: Non-White patients were 18 % less likely to have regional anesthesia for postoperative pain [OR 0.82 (95 % CI; 0.76, 0.9]. Racial minority groups had lower rates of regional anesthesia-Black patients with OR of 0.93 (95 % CI; 0.91, 0.95); Asian patients with OR of 0.84 (95 % CI; 0.81, 0.87); race indicated as Other with OR of 0.78 (95 % CI; 0.71, 0.86). Only 3 studies reported Native Hawaiian and Alaska Native groups and found higher rates of regional anesthesia. Hispanic patients were 20 % less likely to receive regional anesthesia [OR of 0.8 (95 % CI; 0.72, 0.87)]. Three studies found some differences in opioid administration associated with race and ethnicity. A formal meta-analysis was not possible because of the heterogeneity of follow-up and timepoint comparison.

Conclusion: There are racial and ethnic differences in the treatment of acute pain, especially in receipt of regional anesthesia. The most important step forward is the appropriate reporting of racial and ethnic demographic information. Further studies are warranted to understand the process by which differences arise in acute pain management.

Keywords: Acute pain; Ethnic differences; Ethnic disparities; Opioids; Racial differences; Racial disparities; Regional anesthesia.