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F1000Research 2023: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate... (Meta-Analysis)
Meta-Analysis
: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. : A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1 , 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials (RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. General anesthesia resulted in fewer Clavien-Dindo grade II (OR: 0.68; 95% CI: 0.49 - 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 - 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 - 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 - -5.41; p<0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 - -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 - 0.20; p<0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 - 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.
Topics: Humans; Nephrolithotomy, Percutaneous; Anesthesia, Spinal; Anesthesia, General; Anesthesiology; Analgesics
PubMed: 38618023
DOI: 10.12688/f1000research.124704.2 -
British Medical Bulletin Sep 2023It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
It is unclear whether hydrodilatation is beneficial in the management of frozen shoulder compared with other common conservative management modalities. This systematic review evaluates the efficacy of hydrodilatation for the management of frozen shoulder.
SOURCES OF DATA
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An extensive search of PubMed, Embase, Scopus, Cochrane Central, Web of Science and CINAHL databases using multiple keyword combinations of 'shoulder', 'rotator', 'adhesive capsulitis', 'hydrodilatat*', 'distension' since inception of the databases to June 2023 was implemented.
AREAS OF AGREEMENT
Hydrodilatation leads to at least transient more marked improvements in shoulder disability and passive external rotation compared with intra-articular corticosteroid injections.
AREAS OF CONTROVERSY
Hydrodilatation improves passive external rotation in the longer term. Moreover, hydrodilatation may be a preferable option over manipulation under anaesthesia, given its lower cost and better patient convenience.
GROWING POINTS
Intensive mobilization after hydrodilatation is a promising adjuvant treatment option for patients suffering from a frozen shoulder.
AREAS TIMELY FOR DEVELOPING RESEARCH
Although current evidence suggests that hydrodilatation provides a transient improvement in disability in patients with frozen shoulder, its clinical relevance remains unclear. Further research is necessary to establish its role in the management of the condition.
Topics: Humans; Shoulder Joint; Bursitis; Adrenal Cortex Hormones; Injections, Intra-Articular; Anesthesia; Range of Motion, Articular
PubMed: 37496207
DOI: 10.1093/bmb/ldad018 -
World Journal of Surgery Jun 2023Surgery is the preferred treatment option for the elderly patients with hip fractures. However, the choice of general anesthesia (GA) or regional anesthesia (RA) remains... (Meta-Analysis)
Meta-Analysis Review
General Anesthesia Versus Regional Anesthesia in the Elderly Patients Undergoing Hip Fracture Surgeries: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.
BACKGROUND
Surgery is the preferred treatment option for the elderly patients with hip fractures. However, the choice of general anesthesia (GA) or regional anesthesia (RA) remains controversial. The quality of evidence has further improved with the advent of several high-quality randomized clinical trials (RCTs) in the last two years. The purpose of this study was to compare the clinical outcomes of two anesthetic techniques in elderly patients undergoing hip fracture surgeries.
METHODS
Eligible studies were identified from PubMed/MEDLINE, Web of Science, Scopus, EMBASE and reference lists from January 2000 to June 2022 in this current systematic review and meta-analysis. The outcomes included the surgery-related outcomes (duration of surgery, duration of anesthesia, intraoperative blood loss and number of transfusions) and postoperative outcomes (30-day mortality, postoperative delirium,cardiovascular events and other complications).
RESULTS
A total of 10 RCTs were included, and a total of 3594 patients were analyzed. RA was associated with shorter duration of surgery, shorter length of hospital stays and less intraoperative blood loss compared to GA. There were no significant differences between the two groups in the number of blood transfusions, duration of anesthesia, 30-day mortality or postoperative delirium.
CONCLUSIONS
Our pooled analysis identified no significant differences in terms of the safety between RA and GA, while RA reduces intraoperative blood loss, length of hospital stays and duration of surgery. These results suggest that RA appears to be preferable for the elderly patients with hip fractures.
Topics: Humans; Aged; Emergence Delirium; Blood Loss, Surgical; Postoperative Complications; Randomized Controlled Trials as Topic; Anesthesia, General; Anesthesia, Conduction; Hip Fractures
PubMed: 36826487
DOI: 10.1007/s00268-023-06949-y -
Regional Anesthesia and Pain Medicine 2016This systematic review examines the evidence for preprocedural neuraxial ultrasound as an adjunct to lumbar spinal and epidural anesthesia in adults. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review examines the evidence for preprocedural neuraxial ultrasound as an adjunct to lumbar spinal and epidural anesthesia in adults.
METHODS
We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to June 30, 2014, for randomized controlled trials (RCTs) and cohort studies that reported data answering one or more of the following 3 questions: (1) Does ultrasound accurately identify a given lumbar intervertebral space? (2) Does ultrasound accurately predict the needle insertion depth required to reach the epidural or intrathecal space? (3) Does ultrasound improve the efficacy and safety of spinal or lumbar epidural anesthesia?
RESULTS
Thirty-one clinical trials and 1 meta-analysis were included in this review. Data from 8 studies indicate that neuraxial ultrasound can identify a given lumbar intervertebral space more accurately than by landmark palpation alone. Thirteen studies reported an excellent correlation between ultrasound-measured depth and needle insertion depth to the epidural or intrathecal space. The mean difference between the 2 measurements was within 3 mm in most studies. Thirteen RCTs, 5 cohort studies, and 1 meta-analysis reported data on efficacy and safety outcomes. Results consistently showed that ultrasound resulted in increased success and ease of performance. Ultrasound seemed to reduce the risk of traumatic procedures but there was otherwise insufficient evidence to conclude if it significantly improves safety.
CONCLUSIONS
There is significant evidence supporting the role of neuraxial ultrasound in improving the precision and efficacy of neuraxial anesthetic techniques.
WHAT'S NEW
We know that neuraxial ultrasound is a useful complement to clinical examination when performing lumbar central neuraxial blocks. It provides anatomical information including the depth of the epidural space, the identity of a given intervertebral level, and the location of the midline and interspinous/interlaminar spaces. This information can be used to successfully guide subsequent needle insertion.Since 2010, new data from RCTs and 1 meta-analysis suggest that neuraxial ultrasound increases the success and reduces the technical difficulty of lumbar central neuraxial blocks. Findings from the meta-analysis suggest that neuraxial ultrasound reduces the risk of traumatic procedures, and thus may possibly contribute to the safety of lumbar central neuraxial blocks.
Topics: Anesthesia, Epidural; Anesthesia, Spinal; Humans; Lumbar Vertebrae; Randomized Controlled Trials as Topic; Ultrasonography, Interventional
PubMed: 25493689
DOI: 10.1097/AAP.0000000000000184 -
The Cochrane Database of Systematic... Oct 2021Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks that may be minimised by performing the operation under local rather than general anaesthetics. This is an update of a Cochrane Review first published in 1996, and previously updated in 2004, 2008, and 2013.
OBJECTIVES
To determine whether carotid endarterectomy under local anaesthetic: 1) reduces the risk of perioperative stroke and death compared with general anaesthetic; 2) reduces the complication rate (other than stroke) following carotid endarterectomy; and 3) is acceptable to individuals and surgeons.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, and two trials registers (to February 2021). We also reviewed reference lists of articles identified.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing the use of local anaesthetics to general anaesthetics for people having carotid endarterectomy were eligible.
DATA COLLECTION AND ANALYSIS
Three review authors independently extracted data, assessed risk of bias, and evaluated quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. We calculated a pooled Peto odds ratio (OR) and corresponding 95% confidence interval (CI) for the following outcomes that occurred within 30 days of surgery: stroke, death, ipsilateral stroke, stroke or death, myocardial infarction, local haemorrhage, and arteries shunted.
MAIN RESULTS
We included 16 RCTs involving 4839 participants, of which 3526 were obtained from the single largest trial (GALA). The main findings from our meta-analysis showed that, within 30 days of operation, neither incidence of stroke nor death were significantly different between local and general anaesthesia. Of these, the incidence of stroke in the local and general anaesthesia groups was 3.2% and 3.5%, respectively (Peto odds ratio (OR) 0.91, 95% confidence interval (CI) 0.66 to 1.26; P = 0.58; 13 studies, 4663 participants; low-quality evidence). The rate of ipsilateral stroke under both types of anaesthesia was 3.1% (Peto OR 1.03, 95% CI 0.71 to 1.48; P = 0.89; 2 studies, 3733 participants; low-quality evidence). The incidence of stroke or death in the local anaesthesia group was 3.5%, while stroke or death incidence was 4.1% in the general anaesthesia group (Peto OR 0.85, 95% CI 0.62 to 1.16; P = 0.31; 11 studies, 4391 participants; low-quality evidence). A lower rate of death was observed in the local anaesthetic group but evidence was of low quality (Peto OR 0.61, 95% CI 0.35 to 1.06; P = 0.08; 12 studies, 4421 participants).
AUTHORS' CONCLUSIONS
The incidence of stroke and death were not convincingly different between local and general anaesthesia for people undergoing carotid endarterectomy. The current evidence supports the choice of either approach. Further high-quality studies are still needed as the evidence is of limited reliability.
Topics: Anesthesia, General; Anesthesia, Local; Carotid Stenosis; Endarterectomy, Carotid; Humans; Stroke
PubMed: 34642940
DOI: 10.1002/14651858.CD000126.pub5 -
Journal of Clinical Anesthesia Sep 2021Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Moderate to severe postoperative pain occurs in up to 60% of women following breast operations. Our aim was to perform a network meta-analysis and systematic review to compare the efficacy and side effects of different analgesic strategies in breast surgery.
DESIGN
Systematic review and network meta-analysis.
SETTING
Operating room, postoperative recovery room and ward.
PATIENTS
Patients scheduled for breast surgery under general anesthesia.
INTERVENTIONS
Following an extensive search of electronic databases, those who received any of the following interventions, control, local anesthetic (LA) infiltration, erector spinae plane (ESP) block, pectoralis nerve (PECS) block, paravertebral block (PVB) or serratus plane block (SPB), were included. Exclusion criteria were met if the regional anesthesia modality was not ultrasound-guided. Network plots were constructed and network league tables were produced.
MEASUREMENTS
Co-primary outcomes were the pain at rest at 0-2 h and 8-12 h. Secondary outcomes were those related to analgesia, side effects and functional status.
MAIN RESULTS
In all, 66 trials met our inclusion criteria. No differences were demonstrated between control and LA infiltration in regard to the co-primary outcomes, pain at rest at 0-2 and 8-12 h. The quality of evidence was moderate in view of the serious imprecision. With respect to pain at rest at 8-12 h, ESP block, PECS block and PVB were found to be superior to control or LA infiltration. No differences were revealed between control and LA infiltration for outcomes related to analgesia and side effects, and few differences were shown between the various regional anesthesia techniques.
CONCLUSIONS
In breast surgery, regional anesthesia modalities were preferable from an analgesic perspective to control or LA infiltration, with a clinically significant decrease in pain score and cumulative opioid consumption, and limited differences were present between regional anesthetic techniques themselves.
Topics: Anesthesia, Conduction; Breast Neoplasms; Female; Humans; Nerve Block; Network Meta-Analysis; Pain, Postoperative
PubMed: 33873002
DOI: 10.1016/j.jclinane.2021.110274 -
Zhongguo Zhen Jiu = Chinese Acupuncture... Jan 2023To evaluate the clinical value and safety of combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the clinical value and safety of combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery.
METHODS
The randomized controlled trials (RCTs) related to combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery were searched in PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, VIP database, Wanfang database, ClinicalTrials.gov, and the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) from the inception of each database up to July 12, 2022. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool, and Meta-analysis was conducted using RevMan5.4.
RESULTS
A total of 33 RCTs were included, involving 2 526 participants. The Meta-analysis results showed that compared to conventional anesthesia, the patients receiving combined anesthesia of acupuncture-pharmacotherapy had more stable vital signs during surgery, reduced intraoperative fentanyl usage [=-3.73, 95%(-5.28, -2.18), =4.72, <0.000 01], decreased postoperative sufentanil consumption [=-20.85, 95%(-24.84, -16.86), =10.24, <0.000 01], reduced total/effective presses of the postoperative patient-controlled analgesia pump [=-5.70, 95% (-9.04, -2.36), =3.35, =0.000 8], lowered postoperative pain visual analogue scale (VAS) [=-1.63, 95%(-2.02, -1.23), =7.97, <0.000 01], shorter length of postoperative hospital stay [=-1.14, 95%(-1.85, -0.43), =3.15, =0.002], and higher levels of CD 4+ T lymphocytes, CD 8+ T lymphocytes, natural killer (NK) cell activity, and superoxide dismutase (SOD). Additionally, tumor necrosis factor-alpha (TNF-α), adrenaline and cortisol levels were decreased (<0.05). No adverse events related to acupuncture or electrical stimulation were reported, and the incidence of postoperative complications was lower than that of conventional anesthesia [=0.47, 95%(0.36, 0.62), =5.36, <0.000 01].
CONCLUSIONS
The combined anesthesia of acupuncture-pharmacotherapy in pulmonary resection surgery could improve anesthesia and analgesia effectiveness, reduce anesthesia drug usage, regulate immune responses, suppress stress reactions, and the safety is satisfactory. However, there is substantial heterogeneity among the included studies, and outcome measures vary widely. Further large-sample, high-quality, internationally standardized clinical trials are needed to clarify its clinical value and safety, providing reliable evidence for clinical practice.
Topics: Humans; Anesthesia; Acupuncture Therapy; Postoperative Complications; Pain Management; Analgesia, Patient-Controlled
PubMed: 38191169
DOI: 10.13703/j.0255-2930.20221008-0005 -
Anesthesia and Analgesia Jun 2021Intraoperative handoffs between anesthesia clinicians are critical for care continuity. However, such handoffs pose a significant threat to patient safety. This...
Intraoperative handoffs between anesthesia clinicians are critical for care continuity. However, such handoffs pose a significant threat to patient safety. This systematic review synthesizes the empirical evidence on the (a) effect of intraoperative handoffs on outcomes and (b) effect of intraoperative handoff tools on outcomes. All studies on intraoperative handoffs and handoff tools published until September 2019, in any study setting and population, and with no prespecified criteria on the type of comparison and outcome were included. Data extracted from the included studies were aggregated to identify common patterns related to the type of surgery, clinician(s) involved, patient population, handoff tool, the tool design approach (where relevant), tool implementation strategies, and finally, all reported clinical and process outcomes. Quality of studies was assessed using the Newcastle-Ottawa Scale (NOS). Fourteen studies met the inclusion criteria. All included studies used adult patients. Eight studies were retrospective cohort studies that used administrative or electronic health record (EHR)-based databases to investigate the effects of intraoperative handoffs on morbidity and mortality. These studies included a total of 680,855 surgeries, with 139,426 of these surgeries having at least 1 handoff (20.47%). Seven of the studies found a positive association between intraoperative handoffs and considered outcomes. However, a pooled meta-analysis across these studies was not feasible across the retrospective studies due to differing surgical populations and varying definitions of the considered outcomes. Six studies used a nonrandomized prospective design to evaluate the effects of handoff tools on process-based outcomes such as clinician satisfaction, information transfer, handoff duration, and adherence. Five of the 6 handoff tools were checklist based. All prospective tool-based studies relied on small samples and reported a significant improvement on the considered process-based outcomes. The median quality score among retrospective (median [interquartile range {IQR}] = 9 [1]) was significantly higher than that of prospective (median [IQR] = 5 [1.5]) studies (U = 21, P = .0017). This systematic review provides a unique appraisal of the current state of intraoperative handoff research. To improve the quality and outcomes of handoffs, future efforts should focus on design and implementation of standardized handoff tools integrated within EHR systems, consider the use of similar metrics for evaluating handoff process and clinical outcomes, and improve the execution and reporting of studies using standard protocols and guidelines.
Topics: Anesthesia; Humans; Intraoperative Care; Patient Handoff; Retrospective Studies
PubMed: 34032660
DOI: 10.1213/ANE.0000000000005367 -
Annals of Palliative Medicine Nov 2021Several studies have evaluated the association between thermal insulation (TI) and control after surgery, with various research designs, recruitment and exclusion... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies have evaluated the association between thermal insulation (TI) and control after surgery, with various research designs, recruitment and exclusion criteria, and measurements. The current meta-analysis aimed to assess the correlation between TI and stroke during recovery from anesthesia.
METHODS
We searched for full-text articles of us of TI during anesthesia recovery in multiple databases including PubMed, Springer, EMBASE and Chinese journal full-text databases. Two reviewers read each article and extracted the relevant data of into a Microsoft Excel table: name of the first author, publication year, year of onset, sample size (TI/control group), patient age range, and other information related to TI patients and control group. The meta-analysis, sensitivity analysis and bias analysis were performed using Review Manager 5.0.
RESULTS
A total of 723 patients from 7 studies met the eligibility criteria and were included in the final analysis. The meta-analysis showed that the recovery time after anesthesia in the TI group was significantly different from that in the control group [mean difference (MD) =-7.02, 95% confidence interval (CI): -10.10 to -3.95, P<0.00001; P for heterogeneity <0.00001, I2=99%], length of stay in Postanesthesia Care Unit (PACU) score [MD =-20.78, 95% CI: -31.32 to -10.24, P=0.0001; P for heterogeneity <0.00001, I2=92%] and shivering rate [relative risk (RR) =0.25, 95% CI: 0.08 to 0.77, P=0.02; P for heterogeneity =0.07, I2=71%].
DISCUSSION
TI is an important measure during recovery from anesthesia.
Topics: Anesthesia; Body Temperature; Humans; Postoperative Care
PubMed: 34872265
DOI: 10.21037/apm-21-2716 -
Journal of Dental Education Oct 2018The aim of this systematic review was to evaluate the published literature on current educational techniques used to teach local anesthesia administration in U.S. dental... (Review)
Review
The aim of this systematic review was to evaluate the published literature on current educational techniques used to teach local anesthesia administration in U.S. dental schools to determine the methods by which potential complications may be minimized and efficacy maximized. A PubMed search was performed in June 2017 on the following terms: (local anesthesia, education, dental) AND (Humans[Mesh]). Out of 136 articles identified, 13 met the study criteria and were included for review. Of those, the nine with outcome measures were included in the qualitative synthesis. With a quality assessment tool designed for this study, the quality of each included article was assessed independently by three of the authors. Three main pedagogies were identified: didactic instruction based on textbooks and lectures, student-to-student injections, and use of anatomic models. However, the effects of these pedagogies on local anesthesia administration efficacy, patient satisfaction, and student confidence in administering local anesthesia were largely not assessed in these studies. Quality assessment of the reviewed articles yielded a mean score of 62% (range 44-83%) for the observational studies and a mean score of 56% (range 47-63%) for the interventional studies. Due to the heterogeneity of the studies assessed, no meta-analysis could be performed. While the experimental and observational studies reviewed provided some insight into the efficacy of current educational techniques, they had numerous methodological inconsistencies. The inconsistency of the available evidence made it difficult to make fully informed curriculum recommendations based on the existing literature.
Topics: Anesthesia, Dental; Anesthesia, Local; Humans; Schools, Dental; Teaching; United States
PubMed: 30275140
DOI: 10.21815/JDE.018.106