Why Prospect?



There is growing evidence that the efficacy of analgesic agents differs between surgical procedures1

Current analgesic information is often derived by pooling data from a variety of surgical procedures (e.g. numbers needed to treat or harm: NNT or NNH1

Evidence shows that current postoperative pain management is not optimal – See Evidence

Therefore, postoperative pain management protocols may be optimised by examining procedure-specific outcomes1

1. Gray A, Kehlet H, Bonnet F, Rawal N. Predicting postoperative analgesic outcomes: NNT league tables or procedure-specific evidence? Br J Anaesth 2005; 94 (6): 710–14. Abstract

Why procedure-specific recommendations?


The type, level and duration of pain may vary depending on the type of surgery e.g. thoracic vs. abdominal vs. minimally invasive surgery

Some analgesics are only relevant for specific operations e.g. intraperitoneal local anaesthetics, peripheral nerve blocks

The risks and benefits of different analgesics differ between procedures e.g. general vs. neuraxial anaesthesia

Formulating the Recommendations

Clinical Practice

Clinical practice

Practical guidance from the prospect Working Group

e.g. important safety considerations related to the analgesic intervention

Transferable Evidence

Transferable Evidence

  • Usually with a similar pain profile to the specific surgical procedure in question
  • Randomised clinical trials
  • Reviews of randomised clinical trials

Procedure Specific Evidence

Procedure Specific Evidence

This evidence is derived from systematic literature reviews, following the protocol of the Cochrane Collaboration. Inclusion criteria:

– Randomised clinical trials of analgesic, anaesthetic and operative interventions
– Pain scores from a linear pain scale, e.g. visual analogue scale (VAS) or verbal rating scale (VRS)

Outcomes are assessed qualitatively and quantitatively

– Quantitative analyses are performed on postoperative outcomes from more than one study, using Review Manager software1
– Studies that did not report mean and SD data (for continuous variables) or proportion of patients affected (for dichotomous variables), are not included in the meta-analyses

1. RevMan Analyses [Computer program]. Version 1.0 for Windows. In: Review Manager (RevMan) 4.2. Oxford, England: The Cochrane Collaboration, 2003

Prospect Recommendations

Prospect Recomendations

  • Best practice recommendations graded based on the level of evidence, according to the Oxford Centre for Evidence-Based Medicine1
  • Consensus of the prospect Working Group based on the evidence
  • Formulated using the Delphi method, where consensus is derived from discussion2

1.Sackett DL, Straus SE, Richardson WS, et al. Evidence-Based Medicine: How to Practice and Teach EBM. London: Churchill Livingstone, 2000
2.Dalkey N, Helmer O. An experimental application of the Delphi Method to the use of experts. Management Science 1963; 9: 458