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Research article
John A Carter
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8539-5352
License:
This work is licensed under a CC BY 4.0 License. Read Full License
BACKGROUND
The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain.
METHODS
We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000–2019, adult human subjects) of IV nonopioids (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in STATA (v13.0) to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 hours postoperatively (Sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish each treatment by efficacy and safety where higher SUCRA values indicated better outcomes. Treatments were also compared by frequency of opioid-related adverse events (ORADEs) including gastrointestinal and respiratory and reduction in morphine milligram equivalents (MME). The study protocol was prospectively registered with by PROSPERO (CRD42019117360).
RESULTS
Out of 2,313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). Significantly lower MME was associated with MIV for abdominal (vs acetaminophen, ibuprofen and ketorolac), bunionectomy (vs acetaminophen), hysterectomy (vs acetaminophen and ketorolac) and orthopedic procedures (vs acetaminophen and ibuprofen). Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory).
CONCLUSIONS
MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results, as all comparisons involving MIV were indirect.
Keywords
Analgesia, Meloxicam, Opioid, Pain Assessment, Postoperative Pain
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CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Editorial decision: Accept
On 03 Sep, 2020
Review #2 received
Received 01 Sep, 2020
Reviewers invited
Invitations sent on 10 Aug, 2020
Reviewer #1 agreed
On 10 Aug, 2020
Reviewer #2 agreed
On 10 Aug, 2020
Review #1 received
Received 10 Aug, 2020
Editor assigned
On 02 Aug, 2020
Submission checks complete
On 01 Aug, 2020
Editor invited
On 01 Aug, 2020
Version 1
Posted 21 May, 2020
No comments provided
Review #3 received
Received 21 Jun, 2020
Editorial decision: Minor revision
On 21 Jun, 2020
Review #4 received
Received 19 Jun, 2020
Review #7 received
Received 19 Jun, 2020
Review #2 received
Received 16 Jun, 2020
Reviewer #9 agreed
On 15 Jun, 2020
Reviewer #7 agreed
On 15 Jun, 2020
Reviewer #8 agreed
On 15 Jun, 2020
Reviewer #6 agreed
On 13 Jun, 2020
Reviewer #4 agreed
On 12 Jun, 2020
Reviewer #5 agreed
On 12 Jun, 2020
Reviewer #3 agreed
On 26 May, 2020
Review #1 received
Received 26 May, 2020
Reviewer #2 agreed
On 25 May, 2020
Reviewers invited
Invitations sent on 23 May, 2020
Reviewer #1 agreed
On 23 May, 2020
First submitted
On 13 May, 2020
Editor assigned
On 13 May, 2020
Submission checks complete
On 12 May, 2020
Editor invited
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
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A new preprint design is coming!
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See the published version of this preprint at BMC Anesthesiology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
John A Carter
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8539-5352
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Anesthesiology.
No community comments so far
Editorial decision: Accept
On 03 Sep, 2020
Review #2 received
Received 01 Sep, 2020
Reviewers invited
Invitations sent on 10 Aug, 2020
Reviewer #1 agreed
On 10 Aug, 2020
Reviewer #2 agreed
On 10 Aug, 2020
Review #1 received
Received 10 Aug, 2020
Editor assigned
On 02 Aug, 2020
Submission checks complete
On 01 Aug, 2020
Editor invited
On 01 Aug, 2020
Version 1
Posted 21 May, 2020
No comments provided
Review #3 received
Received 21 Jun, 2020
Editorial decision: Minor revision
On 21 Jun, 2020
Review #4 received
Received 19 Jun, 2020
Review #7 received
Received 19 Jun, 2020
Review #2 received
Received 16 Jun, 2020
Reviewer #9 agreed
On 15 Jun, 2020
Reviewer #7 agreed
On 15 Jun, 2020
Reviewer #8 agreed
On 15 Jun, 2020
Reviewer #6 agreed
On 13 Jun, 2020
Reviewer #4 agreed
On 12 Jun, 2020
Reviewer #5 agreed
On 12 Jun, 2020
Reviewer #3 agreed
On 26 May, 2020
Review #1 received
Received 26 May, 2020
Reviewer #2 agreed
On 25 May, 2020
Reviewers invited
Invitations sent on 23 May, 2020
Reviewer #1 agreed
On 23 May, 2020
First submitted
On 13 May, 2020
Editor assigned
On 13 May, 2020
Submission checks complete
On 12 May, 2020
Editor invited
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Anesthesiology.
BACKGROUND
The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain.
METHODS
We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000–2019, adult human subjects) of IV nonopioids (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in STATA (v13.0) to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 hours postoperatively (Sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish each treatment by efficacy and safety where higher SUCRA values indicated better outcomes. Treatments were also compared by frequency of opioid-related adverse events (ORADEs) including gastrointestinal and respiratory and reduction in morphine milligram equivalents (MME). The study protocol was prospectively registered with by PROSPERO (CRD42019117360).
RESULTS
Out of 2,313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). Significantly lower MME was associated with MIV for abdominal (vs acetaminophen, ibuprofen and ketorolac), bunionectomy (vs acetaminophen), hysterectomy (vs acetaminophen and ketorolac) and orthopedic procedures (vs acetaminophen and ibuprofen). Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory).
CONCLUSIONS
MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results, as all comparisons involving MIV were indirect.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
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