Effectiveness of deep general anesthesia compared to the standard depth of general anesthesia for acute postoperative pain and patient safety: a systematic review protocol.

Objective: The objective of this systematic review is to synthesize the best available evidence related to the effectiveness of deep general anesthesia on acute postoperative pain and patient safety in adult patients.

Introduction: Acute postoperative pain is a common physiological side effect of surgery that should be alleviated as soon as possible to reduce suffering and other detrimental effects. Given the adverse effects related to the use of opioids for pain management, and in the current opioid epidemic, evidence-based clinical practice recommendations are needed to reduce the use of opioids in the treatment of acute postoperative pain.

Inclusion criteria: This review will include studies of adult patients that incorporate the intervention of deep general anesthesia (bispectral index values of 45 or less), compared to the provision of a standard depth of general anesthesia (bispectral index values 45-60). Included studies will report acute postoperative pain (within the first 48 hours after surgery) as a primary outcome variable. Secondary outcomes of interest include opioid consumption and any reported adverse outcomes.

Methods: A three-step search strategy will be used to locate studies published in English from 1992 (advent of electroencephalography index monitoring technology) in Ovid MEDLINE, Embase and CINAHL databases. Two independent reviewers will assess retrieved studies against inclusion criteria, complete critical appraisal for methodological quality and extract data using a standardized tool. Data will be synthesized using statistical meta-analysis, where possible.