Good Practice in Postoperative and Procedural Pain Management ...

Evidence tablesEvidence tables are intended to allow the reader a rapidassessment of the strength of supporting evidence for individualanalgesics or analgesic strategies relevant to theprocedure in question. Evidence tabled as ‘Direct’ is thatderived from studies that have specifically investigated theprocedure in question. ‘Indirect’ evidence is derived fromstudies of procedures that the committee considered to besufficiently similar, in terms of expected pain intensity, toallow extrapolation of evidence. Recommendations havenot been formulated on the basis of indirect evidence.1.4 Methodology and evidence grading,good practice pointsSystematic methods were used to search for evidence.Electronic searches were performed on the publishedliterature between January 2006 and December 2011.Search strategies including databases and keywords aredescribed in detail in Appendix 1, the technical report.The bibliographies of meta-analyses, systematicreviews, and review articles published during this periodwere also scrutinized for relevant articles. Studiesin English were included if they were directly relevantto the patient population and procedures. Abstractswere obtained to confirm inclusion or exclusion wherenecessary. Full text versions of included articles wereobtained, a tabulated data extraction method was usedto summarize the articles, and they were graded from1 to 4 according to the criteria in Table 1.Table 1 Criteria for assigning levels of evidenceEvidence levels1 1++ High quality meta-analyses, systematic reviews of RCTs,or RCTs with a very low risk of bias1+ Well-conducted meta-analyses, systematic reviews of RCTs,or RCTs with a low risk of bias1) Meta-analyses, systematic reviews of RCTs, or RCTs with ahigh risk of bias2 2++ High quality systematic reviews of case–control or cohortstudies. High quality case–control or cohort studies with a verylow risk of confounding, bias, or chance and a high probabilitythat the relationship is causal2+ Well-conducted case–control or cohort studies with a lowrisk of confounding, bias, or chance and a moderate probabilitythat the relationship is causal2) Case–control or cohort studies with a high risk ofconfounding, bias, or chance and a significant risk that therelationship is not causal3 Non-analytic studies, e.g. case reports, case series4 Expert opinionRecommendations were formulated, where appropriate,and graded from A to D according to the criteriadescribed in Table 2 using guidance published bythe Scottish Intercollegiate Guidelines Network(SIGN), which are available at: http://www.sign.ac.uk/methodology/index.html and the National Instituteof Clinical Evidence (NICE) http://guidance.nice.org.uk.Table 2 Grading of recommendationsABCDAt least one meta analysis, systematic review, or RCT ratedas 1++, and directly applicable to the target population; or Asystematic review of RCTs or a body of evidence consistingprincipally of studies rated as 1+, directly applicable to the targetpopulation, and demonstrating overall consistency of resultsA body of evidence including studies rated as 2++, directlyapplicable to the target population, and demonstrating overallconsistency of results; or Extrapolated evidence fromstudies rated as 1++ or 1+A body of evidence including studies rated as 2+, directly applicableto the target population and demonstrating overall consistency ofresults; or Extrapolated evidence from studies rated as 2++Evidence level 3 or 4; or Extrapolated evidence from studies ratedas 2+Good practice points indicate best practice based onthe clinical experience and opinion of the guidelinedevelopment committee but not necessarily supportedby research evidence; they are provided in situationswhere published evidence is insufficient to make aformal recommendation but the committee wish toemphasize an important aspect of good practice.1.5 Supplementary materialThe following supplementary material is available forthis guideline:Appendix 1. Technical ReportAppendix 2. Implementation, cost effectiveness andauditAppendix 3. Research implicationsPlease note: Wiley-Blackwell are not responsible forthe content or functionality of any supplementarymaterials supplied by the authors. Any queries (otherthan missing material) should be directed to the correspondingauthor for the article.2 ª 2012 Blackwell Publishing Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79