-
Current Pain and Headache Reports May 2024To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled... (Meta-Analysis)
Meta-Analysis Review
PURPOSE OF REVIEW
To evaluate the effectiveness of radiofrequency neurotomy in managing sacroiliac joint pain utilizing a systematic review with meta-analysis of randomized controlled trials (RCTs) and observational studies.
RECENT FINDINGS
The prevalence of sacroiliac joint pain is estimated at around 25% of low back pain cases, and its diagnosis lacks a gold standard. Treatments include exercise therapy, injections, ablation, and fusion, with variable effectiveness. COVID-19 altered utilization patterns of interventions, including sacroiliac joint procedures, and the evidence for these interventions remains inconclusive. Recently, Medicare has issued its local coverage determinations (LCDs) in the United States, which provides noncoverage of sacroiliac joint radiofrequency neurotomy. Additionally, a recent systematic review of sacroiliac joint injections showed Level III or fair evidence. The sacroiliac joint, a critical axial joint linking the spine and pelvis, contributes to low back pain. Its complex innervation pattern varies among individuals. Sacroiliac joint dysfunction, causing pain and stiffness, arises from diverse factors.The present systematic review and meta-analysis aimed to evaluate radiofrequency neurotomy's effectiveness for sacroiliac joint pain management by applying rigorous methodology, considering both RCTs and observational studies. Despite methodological disparities, the evidence from this review, supported by changes in pain scores and functional improvement, suggests Level III evidence with fair recommendation for radiofrequency neurotomy as a treatment option. The review's strengths include its comprehensive approach and quality assessment. However, limitations persist, including variations in criteria and technical factors, underscoring the need for further high-quality studies in real-world scenarios.
Topics: Sacroiliac Joint; Humans; Low Back Pain; Radiofrequency Ablation; Treatment Outcome; COVID-19; Randomized Controlled Trials as Topic; Denervation
PubMed: 38472618
DOI: 10.1007/s11916-024-01226-6 -
American Journal of Orthopedics (Belle... Jun 2018Pain control following hip arthroscopy presents a significant clinical challenge, with postoperative pain requiring considerable opioid use. Peripheral nerve blocks... (Review)
Review
Pain control following hip arthroscopy presents a significant clinical challenge, with postoperative pain requiring considerable opioid use. Peripheral nerve blocks (PNBs) have emerged as one option to improve pain and limit the consequences of opioid use. The purpose of this study is to provide a comprehensive review of outcomes associated with PNB in hip arthroscopy. We hypothesize that the use of PNB in hip arthroscopy leads to improved outcomes and is associated with few complications. A systematic review of PubMed, Medline, Scopus, and Embase databases was conducted through January 2015 for English-language articles reporting outcome data, with 2 reviewers independently reviewing studies for inclusion. When available, similar outcomes were combined to generate frequency-weighted means. Six studies met the inclusion criteria for this review, reporting on 710 patients undergoing hip arthroscopy. The mean ages were 37.0 and 37.7 years for the PNB and comparator groups, respectively, with a reported total of 281 (40.5%) male and 412 (59.5%) female patients. Postoperative post-anesthesia care unit (PACU) pain was consistently reduced in the PNB group, with the use of a lower morphine equivalent dose and lower rates of inpatient admission, compared with that in the control groups. Postoperative nausea and/or vomiting as well as PACU discharge time showed mixed results. High satisfaction and few complications were reported. In conclusion, PNB is associated with reductions in postoperative pain, analgesic use, and the rate of inpatient admissions, though similar rates of nausea/vomiting and time to discharge were reported. Current PNB techniques are varied, and future research efforts should focus on examining which of these methods provides the optimal risk-benefit profile in hip arthroscopy.
Topics: Arthroscopy; Hip Joint; Humans; Nerve Block; Pain, Postoperative; Treatment Outcome
PubMed: 29979805
DOI: 10.12788/ajo.2018.0049 -
European Spine Journal : Official... Mar 2020To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS... (Review)
Review
AIMS
To examine the strength of evidence available for multiple facet joint injections (FJIs) and medial branch blocks (MBBs), and to report on the variations in the NHS England framework using the getting it right first time (GIRFT) data.
METHODS
Systematic review using patient, intervention, comparison, outcome and study strategy. The literature search using Cochrane, MEDLINE and EMBASE databases using MeSH terms: lumbar spine, spinal injection and facet joint ("Appendix A").
RESULTS
Three studies were identified that investigated the efficacy of multiple FJIs or MBBs. None of these studies reported sustained positive outcomes at long-term follow-up.
CONCLUSION
There is a paucity of levels I and II evidence available for the efficacy of multiple FJIs and MBBs in treating low back pain. GIRFT data show a high degree of variation in the use of multiple FJIs, which would not be supported by the literature. These slides can be retrieved under Electronic Supplementary Material.
Topics: England; Humans; Injections, Intra-Articular; Low Back Pain; Nerve Block; Zygapophyseal Joint
PubMed: 31894402
DOI: 10.1007/s00586-019-06258-w -
Trends in Cardiovascular Medicine Nov 2023Renal denervation (RD) has been investigated as a novel blood pressure (BP) lowering treatment for hypertension. The primary objective of this meta-analysis was to... (Meta-Analysis)
Meta-Analysis Review
Renal denervation (RD) has been investigated as a novel blood pressure (BP) lowering treatment for hypertension. The primary objective of this meta-analysis was to assess the efficacy of RD and factors that may associate with treatment effect heterogeneity. The primary outcomes were raw mean differences (RMD) in 24-hour ambulatory, daytime ambulatory, nighttime, and office systolic BP (SBP) and diastolic BP (DBP) between sham control and RD. A prespecified subgroup analysis was performed comparing studies with follow-up less than versus greater than 4 months. If inter-study heterogeneity was found for any of the above outcomes, additional analyses were performed to assess potential moderator variables. Ten sham-controlled randomized trials were identified and included 1,544 participants, followed for a mean of 4.20 months. RD was associated with a statistically significant reduction in all SBP and DBP measures except for nighttime SBP (-2.64 mmHg; 95% confidence interval (CI) -5.84 to 0.56, p = 0.11) and nighttime DBP (- 1.21 mmHg; 95% CI -3.17 to 0.75, p = 0.23). Mild to moderate inter-study heterogeneity was identified for three outcomes (office SBP and nighttime SBP and DBP). Studies that followed patients for longer than 4 months had numerically lower reductions in most BP outcomes; however, there were no statistically significant interactions between subgroups. Compared to a sham procedure, RD was associated with statistically significant reductions in most measures of SBP and DBP that were within bounds of what would be expected from standard blood pressure lowering medications.
Topics: Humans; Randomized Controlled Trials as Topic; Hypertension; Kidney; Blood Pressure; Sympathectomy; Antihypertensive Agents
PubMed: 35667638
DOI: 10.1016/j.tcm.2022.05.009 -
American Journal of Clinical Dermatology Oct 2015Primary craniofacial hyperhidrosis (CH) can have a profoundly negative impact on quality of life. No comprehensive review of its management exists. (Review)
Review
BACKGROUND
Primary craniofacial hyperhidrosis (CH) can have a profoundly negative impact on quality of life. No comprehensive review of its management exists.
OBJECTIVE
The objective of this review is to present the best clinical evidence to guide CH management.
METHODS
A systematic review was performed using PRISMA guidelines. MEDLINE and EMBASE were searched from 1966 to 2014 for articles using the MeSH terms "Hyperhidrosis", "Head", "Neck" and synonymous text words. Inclusion criteria were experimental and observational studies addressing CH treatment. Two reviewers independently assessed study quality and analysed data.
RESULTS
Of 833 references yielded, 27 met inclusion criteria and were analysed. Twenty-two studies evaluated T2 sympathetic ablation (Level III evidence). Outcome measures were subjective and mean follow-up was 29 months. Reported efficacy was high (70-100%), recurrence rates were generally low (0-8%) and complications largely transient (e.g. pneumothorax 0-1%). However, 8-95.4% experienced troubling compensatory sweating. One randomised controlled trial and one observational study evaluated botulinum toxin A (Level Ib and III, respectively). Both employed objective outcome measures and demonstrated similar findings. Efficacy was 100%, lasted a median of 5-6 months and frontalis muscle inhibition was the main adverse effect (50-100%). Three studies evaluated anticholinergic therapy: topical glycopyrrolate demonstrated high efficacy (96%) with minimal adverse effects (Level Ib) and oral oxybutynin demonstrated relatively high efficacy (80-100%) but with noticeable adverse effects (76.6-83.6%) (Level III).
CONCLUSION
There are few quality studies evaluating CH treatment. Based on available evidence, we recommend topical glycopyrrolate, oral oxybutynin and intradermal botulinum toxin A as first-line therapies due to their efficacy and safety. T2 sympathectomy should be considered for patients refractory to first-line therapy.
Topics: Botulinum Toxins, Type A; Cholinergic Antagonists; Facial Dermatoses; Ganglionectomy; Glycopyrrolate; Head; Humans; Hyperhidrosis; Mandelic Acids; Neck; Neuromuscular Agents
PubMed: 26055729
DOI: 10.1007/s40257-015-0136-6 -
Anesthesia Progress 2018The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?" Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67-3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.
Topics: Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Humans; Mandibular Nerve; Molar; Nerve Block; Pulpitis
PubMed: 29509518
DOI: 10.2344/anpr-65-01-03 -
Anesthesia and Analgesia Aug 2015Paravertebral block (PVB) is a safe and effective anesthetic technique for thoracotomy and mastectomy. However, no systematic review or meta-analysis has focused on PVB... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Paravertebral block (PVB) is a safe and effective anesthetic technique for thoracotomy and mastectomy. However, no systematic review or meta-analysis has focused on PVB for inguinal herniorrhaphy. Our study compares PVB with general anesthesia/systemic analgesia, neuraxial blocks, and other peripheral nerve blocks.
METHODS
We analyzed 14 randomized controlled trials from PubMed, MEDLINE, CENTRAL, EMBASE, and CINAHL up to February 2015, without language restriction, comparing PVB under sedation with general anesthesia/systematic analgesia (135 vs 133 patients), neuraxial blocks (191 vs 186 patients), and other peripheral nerve blocks (119 vs 117 patients). We investigated pain scores, consumption of postoperative analgesia, incidence of postoperative nausea and vomiting (PONV), length of hospital stay, postanesthesia care unit bypassing rate, time to perform blocks, intraoperative hemodynamics, and incidence of urinary retention. Joint hypothesis testing was adopted for pain and analgesics, PONV, and hemodynamic variables. All analyses were performed with RevMan 5.2.11 (Cochrane Collaboration, Copenhagen). Hartung-Knapp-Sidik-Jonkman method was used for post hoc testing.
RESULTS
PVB reduced PONV (nausea: risk ratio [RR] = 0.22; 95% confidence interval [CI], 0.05-0.93; numbers needed to treat [NNT] = 4.5; I = 15% and vomiting: RR = 0.15; 95% CI, 0.03-0.76; NNT = 8.3; I = 0%) compared with general anesthesia/systematic analgesia (quality of evidence [QoE]: high). Compared with neuraxial blocks, PVB resulted in less postoperative nausea (RR = 0.34 [95% CI, 0.13-0.91], NNT = 8.3, I = 0%) and urinary retention (RR = 0.14 [95% CI, 0.05-0.42], NNT = 7.4, I = 0%) than neuraxial blocks (QoE: high). More time was needed to perform PVB than neuraxial blocks (standardized mean difference = 1.90 [95% CI, 0.02-3.77], I = 92%; mean difference = 5.33 minutes; QoE: moderate). However, the available data could not reject the null hypothesis of noninferiority on all pain scores and analgesic requirements for both PVB versus general anesthesia/systematic analgesia and PVB versus neuraxial blocks (QoE: low), as well as on hemodynamic outcomes for PVB versus neuraxial blocks (QoE: moderate). Our systematic review showed that PVB decreased postoperative pain scores and analgesic requirement as compared with ilioinguinal block and transversus abdominis plane block.
CONCLUSIONS
This meta-analysis shows that PVB provides an anesthesia with fewer undesirable effects for inguinal herniorrhaphy. The choice between general anesthesia/systematic analgesia, neuraxial blocks, PVB, and other peripheral nerve blocks should be based on time available to perform the block and a complete coverage over the relevant structures by the blocks.
Topics: Analgesics; Chi-Square Distribution; Hernia, Inguinal; Herniorrhaphy; Humans; Length of Stay; Nerve Block; Odds Ratio; Pain Measurement; Pain, Postoperative; Patient Selection; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Risk Factors; Time Factors; Treatment Outcome
PubMed: 26086619
DOI: 10.1213/ANE.0000000000000835 -
Medicine Jul 2016The objective of this study is to systematically evaluate the efficacy of renal denervation (RD), adjusted drugs, or combined therapy for resistant hypertension (RH)... (Meta-Analysis)
Meta-Analysis Review
The objective of this study is to systematically evaluate the efficacy of renal denervation (RD), adjusted drugs, or combined therapy for resistant hypertension (RH) through a systematic review and meta-analysis of controlled studies.Publications were comprehensively searched. Studies that investigated the effects of RD and/or adjusted drugs in lowering blood pressure (BP) were included. After quality assessment and data extraction, subgroup analyzes were first performed according to blinding method. Meta-regression and inverted funnel plots were also conducted.A total of 13 studies containing 1604 RH patients were included. Compared with control, the meta-analysis showed that RD significantly reduced office-based BP and ambulatory BP in 6 months in the unblinded studies, while no significant difference was found in the blinded studies. Meta-regression demonstrated the significant influence of blinding method on BP reduction, and further analysis revealed a significant BP reduction compared with baseline even in the control arm of blinded studies. RD had similar effects compared with adjusted drugs, and combined therapy seemed to further reduce the level of BP.The efficacy of RD was different between blinded and unblinded studies, and our data revealed a significant BP-lowering effect in the control arm of blinded studies, which was helpful to explain this finding. Furthermore, RD seemed to be equivalent to adjusted drugs, and also we suggested a potential advantage of combined therapy of RD and adjusted drugs compared with monotherapy for RH. However, more studies are warranted to better address the issue.
Topics: Antihypertensive Agents; Combined Modality Therapy; Drug Resistance; Humans; Hypertension; Kidney; Models, Statistical; Sympathectomy
PubMed: 27472671
DOI: 10.1097/MD.0000000000003939 -
Scientific Reports Mar 2017We systematically reviewed and compared the clinical outcomes of thoracoscopic sympathectomy (TS) at different denervation levels for palmar hyperhidrosis. We searched... (Meta-Analysis)
Meta-Analysis Review
We systematically reviewed and compared the clinical outcomes of thoracoscopic sympathectomy (TS) at different denervation levels for palmar hyperhidrosis. We searched PubMed, Ovid MEDLINE, EMBASE, Web of Science, ScienceDirect, the Cochrane Library, Scopus and Google Scholar for relevant studies published during 1990-2016. Symptom resolution, patient satisfaction, compensatory sweating (CS), recurrence, dry hands and gustatory sweating were assessed. We selected 13 studies from 2228 for the final analysis. A comparison of T2 vs. T3 TS revealed that T3 TS reduced the risk of CS (95% confidence interval [CI]: 1.36-3.19, p = 0.0007) and moderate-to-severe CS (95% CI: 2.14-7.87, p < 0.0001). No significant differences were found in patient satisfaction, symptom resolution, and incidence of dry hands and gustatory sweating. A comparison of T3 vs. T4 TS revealed that T4 TS reduced the risk of CS (95% CI: 2.87-9.53, p < 0.00001), moderate-to-severe CS (95% CI: 2.54-5.83, p < 0.00001), dry hands (95% CI: 4.07-18.13, p < 0.00001) and gustatory sweating (95% CI: 1.53-7.32, p < 0.003), and improved patient satisfaction. No significant differences were found in symptom resolution and recurrence. T4 TS appears to be more useful than T3 or T2 TS for PH.
Topics: Hand; Humans; Hyperhidrosis; Patient Satisfaction; Sympathectomy; Thoracic Nerves; Thoracoscopy; Treatment Outcome
PubMed: 28273934
DOI: 10.1038/s41598-017-00169-w -
Hypertension (Dallas, Tex. : 1979) Mar 2023Whether and to what extent the reported blood pressure (BP) lowering effects of renal denervation (RDN) are associated with a central sympathoinhibition is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Whether and to what extent the reported blood pressure (BP) lowering effects of renal denervation (RDN) are associated with a central sympathoinhibition is controversial. We examined this issue by performing a meta-analysis of the microneurographic studies evaluating the BP and muscle sympathetic nerve activity (MSNA) responses to RDN in drug-resistant or uncontrolled hypertension (RHT).
METHODS
This analysis comprised 11 studies including a total of >400 RHT patients undergoing RDN and were followed up for 6 months. Evaluation was extended to the relationships of MSNA with clinic heart rate and BP changes associated with RDN.
RESULTS
MSNA showed a significant reduction after RDN (-4.78 bursts/100 heart beats; <0.04), which was also accompanied by a significant systolic (-11.45 mm Hg; <0.002) and diastolic (-5.24 mm Hg; =0.0001) BP decrease. No significant quantitative relationship was found between MSNA and systolic (r=-0.96, =0.19) or diastolic BP (r=-0.97, =0.23) responses to RDN. This was also the case for clinic heart rate (r=0.53, =0.78, respectively), whose post RDN values were not significant different from the pre-RDN ones. More than 10 renal nerves ablations were found to be needed for obtaining a significant sympathoinhibition.
CONCLUSIONS
This meta-analysis, the first ever done on the MSNA responses to RDN, shows that in a consistent number of RHT patients RDN is associated with a significant, although modest, central sympathoinhibition, which appears to be unrelated to the BP lowering effects of the procedure. Thus factors other than the central sympathetic outflow inhibition may concur at the BP lowering effects of RDN.
Topics: Humans; Sympathectomy; Treatment Outcome; Hypertension; Kidney; Sympathetic Nervous System; Blood Pressure; Denervation
PubMed: 36628971
DOI: 10.1161/HYPERTENSIONAHA.122.20503