Created and developed by my Irish colleague Dr. Bryan Reidy (@bryan_reidy) and used locally at his hospital (Beaumont).

These are NOT definitive resources and may NOT be suitable for your purposes.
This is an educational resource only.
By downloading, you accept the disclaimer on Propofology.com

Full Screen Versionhere

Dr. Sergey Motov (USA Emergency Medicine) & Dr. David Lyness (UK ICM/Anaesthetics)
UPDATE - NOVEMBER 2018
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Taken from Dr Motov's work on a CERTA regime.
This is published in conjunction with the CERTA concept explanation here. 
We can all provide superior analgesia by using medication and techniques other than just opioid medications.
This is NOT a definitive list and in all cases, local policies and protocols should be followed. Check your local formularies.
This is NOT a prescribing guideline - it is for EDUCATIONAL information ONLY.

We do not dispute the role of opioids in many spheres of practice, including emergency medicine, ICU and anaesthetics; rather we wish to highlight the pandemic of high opioid and opiate use. There are many medications available to reduce the amount of opioids used.
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You may find, when considering  your analgesia regimes that opioids are not always  the best options for emergency pain issues.
We would advocate the use of nerve blocks in the first instance to control acute pain, when feasible. 

1. DO NOT mix NSAID drugs - ie) don't give two together
2. Caution with using NSAIDs where surgery could be imminent.
3. Caution masking escalating pain that could indicate a surgical emergency
4. Caution with the abuse potential of some drugs such as lyrica/pregabalin
5. When practical, we would suggest Physiotherapy, TENS and other non-pharmacological methods
6. Make sure you know the contraindications for NSAID use & consider a PPI when prescribing them

With respect to alternatives listed for non-radicular back pain, it has been brought to our attention that a new study was presented in 2017 which showed that "diazepam has no benefit when added to naproxen vs placebo" in acute low back pain. See here.

This is a difficult document to see online - so I have included a fullscreen version here and the A3 printable PDF below.

There were 811 references when compiling this document; they can be found below....

£5,774,000 was made as income by the Cochrane Library (in 2016) for publications of Systematic Review. Their total income peaked at £6,805,000 for 2016 as well as them plunging a lot of money (£8.57M) into investing in their 'strategies for 2020'. (See here) This is a big organisation with a lot of clout in the academic world. They had over 9.7 Million downloads of their PDF's (all specialties) in 2016 - I'll be very excited to read this year's report. They have been heralded for years as the barn-door staple of good evidence and systematic review. Hammered into you in medical school, and used by you in the hospital.

My query was; in the past few years, the twittersphere of critical care has been lamenting the era of the 'negative' trial (I hate the term, but we'll leave it at that for now).  I wondered, knowing that so many trials were at best inconclusive or lacking data that could definitively tell us 'if something works' - did systematic reviews, over a period of 15 years in intensive care medicine shed any light as to the quality of evidence of some of these trials, when viewed in the bigger picture of a rigorous systematic review. Moreover, was the data being produced by ICU trials actually allowing us to conclude anything concrete when aggregated.

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This is an informal review of 71 Systematic Reviews of topics in ICM that were obtained as follows:

PubMed Search for Cochrane Database Systematic Reviews (SR's)
[ICU or ITU or Critical Care or Intensive Care] in Title or Abstract
Removed all non-related SR's
Removed older versions of SR's that had been re-worked with new articles added.
Only from the COCHRANE database of systematic reviews.

1. Recorded what the abstract detailed as the 'Quality of Evidence'
2. Recorded any 'difference' seen in the study
3. Recorded any clear recommendation given by the Systematic Review (and marked if unclear)
4. Almost all of the studies called for further research
5. Abstracts can be seen within the main document, as well as authors and dates of publication
6. A summary document, for ease, is included
7. You can see all of these trials via PubMed or CochraneLibrary.com

EVIDENCE QUALITY
You can learn about the 'GRADE' framework of scoring evidence quality here.
19/71 = I was unable to assess with GRADE (many hinted at 'LOW' quality evidence and one stated, "adequate") (26%)
31/71 = Very Low to Low (43%)
1/71 = Low to High (1.4%)
4/71 = Very Low to Moderate (5.6%)
5/71 = Low to Moderate (7%)
4/71 = Moderate (5.6%)
2/71 = Moderate to Good (2.8%)
1/71 = Good (1.4%)
1/71 = Moderate to High (1.4%)
3/71 = High (4.2%)

To make it clear, it appears that if we look at the GRADE of evidence as being 'Very Low to Low' the authors had little to limited confidence in the effect estimate reported by the RCT's involved in the trial.

More worryingly - if you look at the abstracts of the papers that I have included in the visual abstracts below, you will see a number have been downgraded in evidence quality via their risk of bias.

FULLSCREEN (HD) VERSIONS:
SUMMARY FULLSCREEN HERE
PARTS 1-2 (Full Abstracts/Authors etc) HERE
PART 3 (Full Abstracts/Authors etc) HERE

PDF Download to come in due course.

BETTER VIEWED IN:
​FULLSCREEN HERE
​PDF AT BOTTOM

These studies were found on PubMed and are ONLY the ones with completely #FOAMed access.
Interactive Version: FULLSCREEN HERE (HD Quality)
PDF file below

SEE ALL MY TRIAL SUMMARY DOCUMENTS HERE!

FULLSCREEN
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