The PROSPECT process

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The PROSPECT (PROcedure-SPEcific Postoperative Pain ManagemenT) Working Group (PWG) is an international collaboration of anaesthesiologists and surgeons. The PROSPECT initiative aims to provide healthcare professionals with practical procedure-specific pain management recommendations formulated in a way that facilitates clinical decision-making across all the stages of the perioperative period. With rapid changes in perioperative care and implementation of multidisciplinary, early rehabilitation programs (fast track or enhanced recovery programs), which are becoming standard of care, the PROSPECT methodology has been modified to critically analyze each study design with regards to their relevance in current perioperative care practice. The process by which the recommendations are formulated has been refined to take account not only the quality of the available procedure-specific evidence (using the protocol of the Cochrane Collaboration to evaluate randomized controlled trials (RCTs) of analgesic, anaesthetic, and surgical interventions affecting postoperative pain), but also critical expert interpretation of the study design. The refined methodology has been implemented for all procedure reviews performed from 2016 onwards.

Once the procedure to be reviewed has been identified, a subgroup is selected which consists of at least two members of the PWG; external members (i.e., non-PWG members) are invited to join a subgroup, if they have specific expertise in the surgical procedure to be reviewed. In addition, specialists in literature searches and/or data analysis, and research fellows may also be invited to assist with a particular project. The subgroup performs the initial literature search, and reviews all the manuscripts to identify relevant studies for inclusion, assess quality and level of evidence of included studies, create data tables, carry out qualitative and quantitative analyses, critically analyze the design of the included study with regards to their relevance in current perioperative care practice, and draft the summary documents for presentation to the full PWG. The PWG subsequently examines, in detail, each analgesic, anaesthetic or surgical intervention recommended and not recommended by the subgroup, refines them, as necessary, and comes to a consensus agreement on all the recommendations, which are subsequently presented on the website