Efficacy and safety of regional blocks and multimodal analgesia in psychiatric patients at risk of opioid misuse: A systematic review

Table 1 Characteristics of randomized controlled trials

Ref.	Design	Population	Sample size	Intervention	Primary outcome	Follow-up
Ibrahim et al[11], 2022	RCT	Sleeve gastrectomy	60	Opioid-free + regional blocks	Quality of recovery	24 hours
Accurso et al[12], 2025	RCT	Laparoscopic abdominal	120	Opioid-free + regional blocks	Pain scores, opioid consumption	48 hours
Geng et al[14], 2021	RCT	Gynecological surgery	90	Multimodal analgesia + ERAS	Quality of recovery	24 hours
Wang et al[15], 2025	RCT	Major abdominal surgery	200	Esketamine + dexmedetomidine	Opioid consumption	72 hours
Yurttas et al[16], 2023	RCT	Bariatric surgery	80	Systemic lidocaine	Opioid consumption	48 hours
Sakata et al[17], 2020	RCT	Bariatric surgery	62	Intravenous lidocaine	Opioid consumption, discharge criteria	24 hours
Tsaousi et al[13], 2020	RCT	Lumbar laminectomy	74	Magnesium sulfate multimodal	Pain scores, opioid consumption	48 hours
de Dios et al[19], 2023	RCT	Trauma surgery	150	Multimodal pain regimen	Opioid exposure, pain scores	30 days
Sullivan et al[20], 2024	RCT	Post-trauma	88	Collaborative opioid taper	Opioid reduction, functional outcomes	6 months

RCT: Randomized controlled trial; ERAS: Enhanced recovery after surgery.

Table 2 Risk of bias assessment for randomized controlled trials

Ref.	Randomization	Allocation concealment	Blinding participants	Blinding assessors	Incomplete data	Selective reporting	Overall risk
Ibrahim et al[11]	Low	Low	High	Low	Low	Low	Some concerns
Accurso et al[12]	Low	Low	High	Low	Low	Low	Some concerns
Geng et al[14]	Low	Low	Some concerns	Low	Low	Low	Some concerns
Wang et al[15]	Low	Low	Low	Low	Low	Low	Low
Yurttas et al[16]	Low	Low	Low	Low	Low	Low	Low
Sakata et al[17]	Low	Low	Low	Low	Some concerns	Low	Some concerns
Tsaousi et al[13]	Low	Low	Some concerns	Low	Low	Low	Some concerns
de Dios et al[19]	Low	Some concerns	High	Low	Low	Low	Some concerns
Sullivan et al[20]	Low	Low	High	Low	Some concerns	Low	Some concerns

Table 3 Characteristics of observational studies

Ref.	Design	Population	Sample size	Intervention/exposure	Primary outcome	Follow-up
Lenk et al[22], 2022	Retrospective	Tibial fracture with substance abuse	92	Multimodal analgesia	Opioid consumption	30 days
Gedda et al[21], 2023	Retrospective	Colorectal surgery	1256	Multimodal analgesia bundle	Postoperative opioid use	90 days
Wei et al[24], 2019	Retrospective	Trauma patients	15847	Multi-modal pain regimen	Inpatient opioid exposure	Discharge
Oldfield et al[6], 2018	Prospective	Chronic pain with risky opioid use	84	Multimodal treatment including buprenorphine	Treatment outcomes	12 months
Moller et al[23], 1998	Prospective	Elderly surgical patients	1218	Anesthesia techniques	Cognitive dysfunction	3 months
Fingerhood et al[18], 2014	Retrospective	Opioid-dependent patients	302	Buprenorphine vs methadone	Treatment retention	12 months
Wasan et al[3], 2015	Prospective	Chronic low back pain	370	Various treatments	Opioid analgesia and misuse	6 months
Rudolph et al[7], 2024	Retrospective	Medicaid patients	8945	Pain management treatments	Opioid use disorder risk	24 months
Grau-López et al[4], 2014	Cross-sectional	Dual-diagnosis outpatients	186	Medication prescriptions	Prescription patterns	Single time point
Workman et al[5], 2024	Retrospective	Veterans with problematic opioid use	2847	NLP vs diagnostic codes	Identification methods	Variable

Table 4 Newcastle-Ottawa Scale assessment for observational studies

Ref.	Selection (4 stars)	Comparability (2 stars)	Outcome (3 stars)	Total score
Lenk et al[22]	3	1	2	6/9
Gedda et al[21]	4	2	3	9/9
Wei et al[24]	4	2	2	8/9
Oldfield et al[6]	3	1	3	7/9
Moller et al[23]	4	1	3	8/9
Fingerhood et al[18]	3	2	2	7/9
Wasan et al[3]	3	2	3	8/9
Rudolph et al[7]	4	2	2	8/9
Grau-López et al[4]	2	1	2	5/9
Workman et al[5]	3	1	2	6/9

Table 5 The Grading of Recommendations Assessment, Development, and Evaluation quality assessment

Outcome	Study types	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Quality rating
Opioid consumption reduction	9 RCTs, 6 observational	Serious	Not serious	Serious	Not serious	Undetected	⊕⊕⊕○ moderate
Pain scores	7 RCTs, 4 observational	Serious	Serious	Serious	Serious	Undetected	⊕⊕○○ low
Quality of recovery	4 RCTs	Not serious	Not serious	Serious	Serious	Undetected	⊕⊕○○ low
Adverse events	8 RCTs, 5 observational	Serious	Not serious	Not serious	Serious	Undetected	⊕⊕○○ low
Length of stay	5 RCTs, 3 observational	Serious	Serious	Not serious	Not serious	Undetected	⊕⊕○○ low

RCTs: Randomized controlled trials.