Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Clin Cases. May 6, 2026; 14(13): 119779
Published online May 6, 2026. doi: 10.12998/wjcc.v14.i13.119779
Published online May 6, 2026. doi: 10.12998/wjcc.v14.i13.119779
Efficacy and safety of regional blocks and multimodal analgesia in psychiatric patients at risk of opioid misuse: A systematic review
Hersh Tilokani, Department of Medicine, Rocky Vista University College of Osteopathic Medicine, Colorado, CA 90095, United States
Ahsan Shahzad, Department of Psychiatry, Rasheed Neuro Care Hospital, Faisalabad 38000, Punjab, Pakistan
Bismah Rafique Malik, Inshal Jawed, Department of Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
Anmol Shehzadi, Department of Anesthesiology, King Faisal Specialist Hospital & Research Center, Riyadh 11211, Saudi Arabia
Abu Huraira Bin Gulzar, Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Pakistan
Abdul Rehman, Department of Anesthesiology, Kulsum International Hospital, Islamabad 44000, Pakistan
Jibran Ikram, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Jibran Ikram, Center for Outcomes Research, Department of Anesthesiology, UTHealth, Houston, TX 77030, United States
Suleman Khan, Department of Medicine, Khyber Medical College, Peshawar 25160, Pakistan
Madho Mal, Department of Internal Medicine, Marshall Community Health Consortium, Huntington, WV 25701, United States
Mohammad Ali Zakeri, Department of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan 7718796755, Kermān, Iran
Co-first authors: Hersh Tilokani and Ahsan Shahzad.
Author contributions: Tilokani H, Shahzad A, and Jawed I conceptualized and designed the study, formulated the research objectives, and supervised the overall project; Tilokani H and Shahzad A contributed equally to this work and share first authorship; Rafique Malik B, Shehzadi A, Bin Gulzar AH, and Ikram J were responsible for literature screening, data acquisition, and execution of the research protocol; Shahzad A, Khan S, and Mal M contributed to methodological development, provided clinical and academic expertise, and assisted in interpretation of the findings; Shahzad A and Zakeri MA contributed to study validation, critical methodological review, and provided institutional research support; Zakeri A, Rehman A, and Tilokani H performed the statistical analysis and drafted the initial manuscript; and all authors critically revised the manuscript for important intellectual content, approved the final version for submission, and agreed to be accountable for all aspects of the work.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Inshal Jawed, MBBS, Department of Medicine, Dow University of Health Sciences, Baba-e-urdu Karachi, Karachi 75350, Sindh, Pakistan. inshaljwd@gmail.com
Received: February 9, 2026
Revised: February 26, 2026
Accepted: March 17, 2026
Published online: May 6, 2026
Processing time: 73 Days and 19 Hours
Revised: February 26, 2026
Accepted: March 17, 2026
Published online: May 6, 2026
Processing time: 73 Days and 19 Hours
Core Tip
Core Tip: Regional blocks and multimodal analgesia reduce perioperative opioid use while preserving effective pain control. These approaches benefit surgical patients at high risk of opioid misuse including those with psychiatric illness. Evidence specific to psychiatric populations remains limited and optimal strategies should be tailored to the psychiatric profile surgical context and long term risk of dependence.