Optimal recovery after surgery depends upon effective perioperative pain management. The PROSPECT (PROcedure-SPECific postoperative pain managemenT) initiative, a collaboration of anaesthesiologists and surgeons with broad international representation, provides healthcare professionals with practical, procedure-specific pain management recommendations, formulated in a way that facilitates clinical decision-making across all stages of the perioperative period. Recommendations are based on a systematic review and critical analysis of available procedure-specific evidence.
With rapid changes in perioperative care and implementation of multidisciplinary, early rehabilitation programs (fast track or enhanced recovery programs), which are becoming standard of care, the PROSPECT methodology has been modified to critically analyse the design of each study with regards to its relevance in current perioperative care practice. The process by which the recommendations are formulated has been refined to take account of not only the quality of the available procedure-specific evidence, but also critical expert interpretation of the study design. The refined methodology has been implemented for all procedure reviews performed from 2016 onwards. A detailed description of the methodology has been published and is freely accessible: Joshi et al 2019.
Once the procedure to be reviewed has been identified, a subgroup is selected which consists of at least two members of the PWG (including the subgroup lead). External members (i.e. non-PWG members) are invited to join a subgroup, if they have specific expertise in the surgical procedure to be reviewed. In addition, specialists in literature searches and/or data analysis, and research fellows may also be invited to assist with a particular project.
The subgroup performs the initial literature search, and reviews all the manuscripts to identify relevant studies for inclusion, assesses the quality and level of evidence of included studies, creates data tables, carries out qualitative and quantitative analyses, critically analyses the design of the included studies with regards to their relevance in current perioperative care practice, and drafts the summary documents for presentation to the full PWG.
The PWG subsequently examines, in detail, each analgesic, anaesthetic or surgical intervention recommended and not recommended by the subgroup. The PWG refines the recommendations, as necessary, and comes to a consensus agreement on all the recommendations, which are subsequently presented on the website.
The processes of performing the systematic review and formulating the recommendations are outlined below. For full details, please access the PROSPECT methodology publication: Joshi et al 2019.
Allocation concealment is rated as: A, adequate; B, unclear; C, inadequate; D, not used.
The grade of recommendation is based on the overall level of evidence, considering the balance of clinical practice information and evidence.
NA: not applicable