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Journal of the American Dental... Feb 2020The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis.
TYPES OF STUDIES REVIEWED
The authors conducted a search of MEDLINE databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Brazilian Library of Dentistry). There was no restriction on publication year or idiom. The gray literature was also explored. The authors included only randomized clinical trials that compared different anesthetics in the efficacy of IANB in patients with irreversible pulpitis. The risk of bias was evaluated by using the Cochrane Collaboration's tool. A random-effects Bayesian mixed treatment comparison model was used to compare different anesthetic solutions in randomized clinical trials with low or unclear risk of bias. Heterogeneity was assessed by using Cochran Q test and I statistics. Quality of evidence was assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
A total of 7,981 studies were identified; only 16 met the eligibility criteria, and they were all meta-analyzed. A significant difference was observed in the pair lidocaine versus articaine, with higher success with articaine (risk ratio, 0.76; 95% confidence interval, 0.63 to 0.88) in the mixed treatment comparison analysis, as this comparison was graded as high-quality evidence. The probability of success for each treatment was 73% for articaine, 57% for prilocaine, 55% for mepivacaine, 53% for bupivacaine, and 12% for lidocaine. This ranking was considered high quality of evidence.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
The use of articaine can increase the IANB success rate in patients with irreversible pulpitis. Among the anesthetic solutions, lidocaine was the least effective.
Topics: Anesthesia, Dental; Anesthetics, Local; Bayes Theorem; Brazil; Double-Blind Method; Humans; Lidocaine; Mandibular Nerve; Nerve Block; Pulpitis
PubMed: 31813471
DOI: 10.1016/j.adaj.2019.09.002 -
The Cochrane Database of Systematic... Dec 2019Spinal anaesthesia has been implicated as one of the possible causes of neurological complications following surgical procedures. This painful condition,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Spinal anaesthesia has been implicated as one of the possible causes of neurological complications following surgical procedures. This painful condition, occurring during the immediate postoperative period, is termed transient neurological symptoms (TNS) and is typically observed after the use of spinal lidocaine. Alternatives to lidocaine that can provide high-quality anaesthesia without TNS development are needed. This review was originally published in 2005, and last updated in 2009.
OBJECTIVES
To determine the frequency of TNS after spinal anaesthesia with lidocaine and compare it with other types of local anaesthetics by performing a meta-analysis for all pair-wise comparisons, and conducting network meta-analysis (NMA) to rank interventions.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Elsevier Embase, and LILACS on 25 November 2018. We searched clinical trial registries and handsearched the reference lists of trials and review articles.
SELECTION CRITERIA
We included randomized and quasi-randomized controlled trials comparing the frequency of TNS after spinal anaesthesia with lidocaine to other local anaesthetics. Studies had to have two or more arms that used distinct local anaesthetics (irrespective of the concentration and baricity of the solution) for spinal anaesthesia in preparation for surgery. We included adults who received spinal anaesthesia and considered all pregnant participants as a subgroup. The follow-up period for TNS was at least 24 hours.
DATA COLLECTION AND ANALYSIS
Four review authors independently assessed studies for inclusion. Three review authors independently evaluated the quality of the relevant studies and extracted the data from the included studies. We performed meta-analysis for all pair-wise comparisons of local anaesthetics, as well as NMA. We used an inverse variance weighting for summary statistics and a random-effects model as we expected methodological and clinical heterogeneity across the included studies resulting in varying effect sizes between studies of pair-wise comparisons. The NMA used all included studies based on a graph theoretical approach within a frequentist framework. Finally, we ranked the competing treatments by P scores.
MAIN RESULTS
The analysis included 24 trials reporting on 2226 participants of whom 239 developed TNS. Two studies are awaiting classification and one is ongoing. Included studies mostly had unclear to high risk of bias. The NMA included 24 studies and eight different local anaesthetics; the number of pair-wise comparisons was 32 and the number of different pair-wise comparisons was 11. This analysis showed that, compared to lidocaine, the risk ratio (RR) of TNS was lower for bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine with RRs in the range of 0.10 to 0.23 while 2-chloroprocaine and mepivacaine did not differ in terms of RR of TNS development compared to lidocaine. Pair-wise meta-analysis showed that compared with lidocaine, most local anaesthetics were associated with a reduced risk of TNS development (except 2-chloroprocaine and mepivacaine) (bupivacaine: RR 0.16, 95% confidence interval (CI) 0.09 to 0.28; 12 studies; moderate-quality evidence; 2-chloroprocaine: RR 0.09, 95% CI 0.01 to 1.51; 2 studies; low-quality evidence; levobupivacaine: RR 0.13, 95% CI 0.02 to 0.69; 2 studies; low-quality evidence; mepivacaine: RR 1.01, 95% CI 0.18 to 5.82; 4 studies; very low-quality evidence; prilocaine: RR 0.18, 95% CI 0.07 to 0.49; 4 studies; moderate-quality evidence; procaine: RR 0.14, 95% CI 0.04 to 0.52; 2 studies; moderate-quality evidence; ropivacaine: RR 0.10, 95% CI 0.01 to 0.78; 2 studies; low-quality evidence). We were unable to perform any of our planned subgroup analyses due to the low number of TNS events.
AUTHORS' CONCLUSIONS
Results from both NMA and pair-wise meta-analysis indicate that the risk of developing TNS after spinal anaesthesia is lower when bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine are used compared to lidocaine. The use of 2-chloroprocaine and mepivacaine had a similar risk to lidocaine in terms of TNS development after spinal anaesthesia. Patients should be informed of TNS as a possible adverse effect of local anaesthesia with lidocaine and the choice of anaesthetic agent should be based on the specific clinical context and parameters such as the expected duration of the procedure and the quality of anaesthesia. Due to the very low- to moderate-quality evidence (GRADE), future research efforts in this field are required to assess alternatives to lidocaine that would be able to provide high-quality anaesthesia without TNS development. The two studies awaiting classification and one ongoing study may alter the conclusions of the review once assessed.
Topics: Anesthesia, Local; Anesthesia, Spinal; Anesthetics, Local; Humans; Lidocaine; Network Meta-Analysis; Pain; Peripheral Nervous System Diseases; Randomized Controlled Trials as Topic
PubMed: 31786810
DOI: 10.1002/14651858.CD003006.pub4 -
The European Journal of Contraception &... Jun 2018Systematic review and meta-analysis to assess the effects of uterine or paracervical lidocaine application on pain control during IUD insertion. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Systematic review and meta-analysis to assess the effects of uterine or paracervical lidocaine application on pain control during IUD insertion.
METHODS
PubMed and five other electronic research databases were searched through 15 November 2017 for RCTs comparing lidocaine treatment vs. a control (placebo or no-intervention) to prevent pain during IUD insertion. Searched terms included 'IUD insertion', 'lidocaine' and 'randomised controlled trial'. RCTs evaluating lidocaine treatment before IUD insertion without restriction of language, age and IUD type. Pain measured by visual pain scales at tenaculum placement, IUD insertion and immediate post-IUD insertion. Results of random effects meta-analyses were reported as mean differences (MDs) of visual pain scale (VPS) scores and their 95% confidence intervals (CIs).
RESULTS
Eleven RCTs (n = 1458 women) reporting paracervical lidocaine block or uterine mucosa lidocaine application before IUD insertion. Lidocaine produced lower VPS scores during tenaculum placement (MD -0.99, 95% CI: -1.73 to -0.26), IUD insertion (MD -1.26, 95% CI: -2.23 to -0.29) and immediate post-IUD insertion period (MD -1.25, 95% CI: -2.17 to -0.33).
CONCLUSION
Lidocaine treatment was associated with modest reduction of pain during tenaculum placement and after IUD insertion.
Topics: Anesthetics, Local; Female; Humans; Intrauterine Devices; Lidocaine; Pain; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 29792756
DOI: 10.1080/13625187.2018.1469124 -
PloS One 2020A systematic review and meta-analysis was conducted to explore the effect of a eutectic mixture of local anaesthetics (EMLA) on pain reduction during extracorporeal... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis was conducted to explore the effect of a eutectic mixture of local anaesthetics (EMLA) on pain reduction during extracorporeal shockwave lithotripsy (ESWL). PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated March 2020) were searched for randomised controlled trials (RCTs) assessing the effect of EMLA for patients that underwent ESWL. The search strategy and study selection process were managed according to the PRISMA statement. Six RCTs were included in the meta-analysis. Overall, the results indicated that EMLA significantly reduced pain compared to the control group (RR = -2.98, 95% CI = -5.82 to -0.13, P = 0.04) with a heterogeneity of I2 = 57% (P = 0.04). Subgroup analysis showed that EMLA did not significantly reduce pain when the patients took an analgesic premedication (RR = -1.46, 95% CI = -5.89 to 2.98, P = 0.52) with a heterogeneity of I2 = 38% (P = 0.52). Conversely, studies without premedication showed a significant pain relief effect (RR = -4.08, 95% CI = -7.36 to -0.65, P = -0.80) with a heterogeneity of I2 = 48% (P = 0.14). Most studies showed there was no difference in the patient's need for analgesics. EMLA was effective for reducing pain during EWSL. However, this analgesic effect was limited and did not reduce the need for analgesics.
Topics: Administration, Cutaneous; Analgesia; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Humans; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Pain Management; Pain, Postoperative
PubMed: 33017397
DOI: 10.1371/journal.pone.0237783 -
Journal of Anesthesia Apr 2019Although many drugs or interventions have been studied to manage catheter-related bladder discomfort (CRBD), their comparative effectiveness is unknown. We attempted to... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Although many drugs or interventions have been studied to manage catheter-related bladder discomfort (CRBD), their comparative effectiveness is unknown. We attempted to assess the comparative effectiveness of the strategies to manage CRBD in patients undergoing urologic surgery including amikacin, solifenacin, darifenacin, butylscopolamine, dexmedetomidine, gabapentin, glycopyrrolate, ketamine, oxybutynin, resiniferatoxin, tolterodine, tramadol, caudal block, dorsal penile nerve block, lidocaine-prilocaine cream.
METHODS
We performed an arm-based network meta-analysis including 29 trials with 2841 participants. Goodness of model fit was evaluated by deviance information criteria (DIC). The incidence of CRBD at 0, 1, and 6 h after surgery and the incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery were compared.
RESULTS
Random effect model was selected according to DIC. Most of the drugs significantly decreased the incidence of CRBD except amikacin, tramadol at 0 and 1 h after surgery. Dexmedetomidine, solifenacin, caudal block, dorsal penile nerve block, resiniferatoxin, and gabapentin 1200 mg p.o. significantly decreased the incidence of CRBD at 6 h after surgery (gabapentin 1200: Odds ratio [OR] 0.02; SUCRA 95.6). Dexmedetomidine and tolterodine significantly decreased the incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery (tolterodine at 6 h: OR 0.05; SUCRA 73.7).
CONCLUSIONS
Gabapentin was ranked best regarding the overall incidence of CRBD, while tolterodine was ranked best in reducing the severity of CRBD. However, a firm conclusion cannot be made from our analysis due to small-study number and heterogeneity regarding study setting and outcome measurement.
Topics: Humans; Network Meta-Analysis; Pain, Postoperative; Postoperative Period; Urinary Catheterization; Urinary Catheters
PubMed: 30603826
DOI: 10.1007/s00540-018-2597-2 -
Pediatrics Jan 2019: media-1vid110.1542/5852339542001PEDS-VA_2018-1173 CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain during venipuncture in... (Meta-Analysis)
Meta-Analysis
UNLABELLED
: media-1vid110.1542/5852339542001PEDS-VA_2018-1173 CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain during venipuncture in infants.
OBJECTIVE
To determine the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia.
DATA SOURCES
Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions.
STUDY SELECTION
We selected randomized controlled trials in which researchers compared EMLA with nonpharmacological interventions.
DATA EXTRACTION
Two reviewers independently performed abstract screening and full-text review, and extracted the data and assessed the risk of bias.
RESULTS
Ten randomized controlled trials (907 infants) were included. EMLA revealed little or no effect in reduction of pain (standardized mean difference: 0.14; 95% confidence interval [CI]: -0.17 to 0.45; 6 trials, = 742; moderate-quality evidence) when EMLA was compared with sucrose, breastfeeding, or placebo. In comparison with placebo, EMLA revealed a small-to-moderate effect on increasing methemoglobin levels (mean difference: 0.35; 95% CI: 0.04 to 0.66; 2 trials, = 134; low-quality evidence). There was an increased risk of blanching of the skin in the EMLA group (relative risk: 2.63; 95% CI: 1.58 to 4.38; 2 trials, = 123; I = 84%, very low-quality evidence).
LIMITATIONS
Our results may not be applicable to older infants.
CONCLUSIONS
EMLA reveals minimal benefits in terms of reduction of pain due to venipuncture procedure in comparison with placebo and no benefit in comparison with sucrose and/or breastfeeding. Moreover, it produced an elevation in methemoglobin levels and skin blanching.
Topics: Anesthetics, Combined; Humans; Infant; Lidocaine, Prilocaine Drug Combination; Pain; Pain Management; Pain Measurement; Phlebotomy; Skin Diseases; Treatment Outcome
PubMed: 30587535
DOI: 10.1542/peds.2018-1173 -
Medical Science Monitor : International... May 2020BACKGROUND The efficacy of a eutectic mixture of local anesthetics (EMLA) for pain control in extracorporeal shock wave lithotripsy is unclear. The aim of this study was... (Meta-Analysis)
Meta-Analysis
BACKGROUND The efficacy of a eutectic mixture of local anesthetics (EMLA) for pain control in extracorporeal shock wave lithotripsy is unclear. The aim of this study was to assess the effect of EMLA cream on pain control during extracorporeal shock wave lithotripsy. MATERIAL AND METHODS We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials that compared the pain control efficacies of EMLA vs. placebo. Study eligibility criteria, participants, and interventions: Randomized controlled trials that compared the effect of EMLA with placebo cream for patients underwent extracorporeal shock wave lithotripsy. Study appraisal and synthesis methods: Two review authors extracted data independently using a designed data extraction form and risk of bias by Cochrane Collaboration's tool. RESULTS Nine studies, including 10 randomized controlled trials with 1167 patients, were eligible. The EMLA group experienced less pain (mean difference, -0.47; 95% confidence interval, -0.78 to -0.16; p=0.003) and shorter duration of lithotripsy (mean difference, -1.70, 95% confidence interval: -2.31 to -1.10, p<0.0001) than the placebo group. There were no significant differences in the number of patients who needed extra intravenous medication (p=0.610), number of patients with insufficient extracorporeal shock wave lithotripsy pain control (p=0.530), and number of patients with opioid adverse effects (p=0.320). Limitations: Long interval between the studies, different kinds of lithotripters. CONCLUSIONS EMLA can reduce pain during the ESWL procedure.
Topics: Analgesia; Analgesics, Opioid; Anesthesia, Local; Anesthetics, Combined; Anesthetics, Local; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Lithotripsy; Pain; Pain Management; Pain Measurement
PubMed: 32400392
DOI: 10.12659/MSM.921063