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Biomedicines Sep 2023This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying... (Review)
Review
This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.
PubMed: 37892981
DOI: 10.3390/biomedicines11102606 -
Medicina (Kaunas, Lithuania) Apr 2023To analyze the effects of several drug for pain prevention in adults undergoing craniotomy for elective brain surgery. A systematic review and meta-analysis were... (Meta-Analysis)
Meta-Analysis Review
To analyze the effects of several drug for pain prevention in adults undergoing craniotomy for elective brain surgery. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated the effectiveness of pharmacological treatments for preventing post-operative pain in adults (aged 18 years or older) undergoing craniotomies. The main outcome measures were represented by the mean differences in validated pain intensity scales administered at 6 h, 12 h, 24 h and 48 h post-operatively. The pooled estimates were calculated using random forest models. The risk of bias was evaluated using the RoB2 revised tool, and the certainty of evidence was assessed according to the GRADE guidelines. In total, 3359 records were identified through databases and registers' searching. After study selection, 29 studies and 2376 patients were included in the meta-analysis. The overall risk of bias was low in 78.5% of the studies included. The pooled estimates of the following drug classes were provided: NSAIDs, acetaminophen, local anesthetics and steroids for scalp infiltration and scalp block, gabapentinoids and agonists of adrenal receptors. High-certainty evidence suggests that NSAIDs and acetaminophen may have a moderate effect on reducing post-craniotomy pain 24 h after surgery compared to control and that ropivacaine scalp block may have a bigger impact on reducing post-craniotomy pain 6 h after surgery compared to control. Moderate-certainty evidence indicates that NSAIDs may have a more remarkable effect on reducing post-craniotomy pain 12 h after surgery compared to control. No moderate-to-high-certainty evidence indicates effective treatments for post-craniotomy pain prevention 48 h after surgery.
Topics: Adult; Humans; Acetaminophen; Randomized Controlled Trials as Topic; Pain, Postoperative; Brain; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 37241063
DOI: 10.3390/medicina59050831 -
The Journal of Arthroplasty Oct 2022Periarticular injection (PAI) is administered intraoperatively to help reduce postoperative pain and opioid consumption after primary total joint arthroplasty (TJA). The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periarticular injection (PAI) is administered intraoperatively to help reduce postoperative pain and opioid consumption after primary total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of PAI in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Medicine.
METHODS
The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published prior to March 2020 on PAI in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of PAI.
RESULTS
Three thousand six hundred and ninety nine publications were critically appraised to provide 60 studies regarded as the best available evidence for an analysis. The meta-analysis showed that intraoperative PAI reduces postoperative pain and opioid consumption. Adding ketorolac or a corticosteroid to a long-acting local anesthetic (eg, ropivacaine or bupivacaine) provides an additional benefit. There is no difference between liposomal bupivacaine and other nonliposomal long-acting local anesthetics. Morphine does not provide any additive benefit in postoperative pain and opioid consumption and may increase postoperative nausea and vomiting. There is insufficient evidence to draw conclusions on the use of epinephrine and clonidine.
CONCLUSION
Strong evidence supports the use of a PAI with a long-acting local anesthetic to reduce postoperative pain and opioid consumption. Adding a corticosteroid and/or ketorolac to a long-acting local anesthetic further reduces postoperative pain and may reduce opioid consumption. Morphine has no additive effect and there is insufficient evidence on epinephrine and clonidine.
Topics: Analgesics, Opioid; Anesthetics, Local; Arthroplasty, Replacement, Knee; Bupivacaine; Clonidine; Epinephrine; Humans; Injections, Intra-Articular; Ketorolac; Morphine; Pain Management; Pain Measurement; Pain, Postoperative; Ropivacaine
PubMed: 36162925
DOI: 10.1016/j.arth.2022.03.045 -
Journal of Gynecology Obstetrics and... Oct 2021To systematically and meta-analytically examine the efficacy of ropivacaine versus lidocaine infiltration for controlling postpartum perineal pain secondary to... (Meta-Analysis)
Meta-Analysis
AIM
To systematically and meta-analytically examine the efficacy of ropivacaine versus lidocaine infiltration for controlling postpartum perineal pain secondary to spontaneous tear or selective episiotomy.
METHODS
We searched four databases from inception to 20-September-2020. We included all relevant randomized and nonrandomized studies and assessed their risk of bias. We pooled data as standardized mean difference (SMD), weighted mean difference (WMD), or odds ratio (OR) with 95 % confidence intervals (95 % CIs).
RESULTS
Four studies met the inclusion criteria (one and three studies were nonrandomized and randomized, respectively). There were 405 patients; 205 and 200 patients received lidocaine and ropivacaine, respectively. There was no significant difference between ropivacaine and lidocaine groups with regard to visual analogue scale (VAS) pain scores at suturing (WMD = -0.04, 95 % CI [-0.41, 0.32], P = 0.82), 2 h (SMD = -1.50, 95 % CI [-3.50, 0.50], P = 0.14), and 24 h (SMD = -0.40, 95 % CI [-1.15, 0.34], P = 0.29) post repair of perineal trauma. Proportion of patients with mild VAS pain score ≤3 at 24 h was significantly higher in the ropivacaine group (OR = 4.34, 95 % CI [2.03, 9.29], P < 0.001). Proportion of patients who did not require additional analgesia during the first 24 h post perineal repair did not significantly differ between both groups (OR = 2.44, 95 % CI [0.09, 68.21], P = 0.60). Ropivacaine group achieved higher maternal satisfaction (OR = 7.13, 95 % CI [3.63, 13.99], P < 0.001).
CONCLUSIONS
During repair of postpartum perineal trauma, pain efficacy is relatively longer with ropivacaine but safety is not well investigated. High-quality and large-sized studies are needed to consolidate these findings.
Topics: Adult; Anesthesia, Local; Female; Humans; Lidocaine; Pain; Pain Management; Pain Measurement; Perineum; Postpartum Period; Pregnancy; Ropivacaine
PubMed: 33515853
DOI: 10.1016/j.jogoh.2021.102074 -
PloS One 2023Ropivacaine is a long-acting local anesthetic that is used to treat postoperative pain. Adjuvant use of dexmedetomidine in regional anesthesia may prolong the duration... (Meta-Analysis)
Meta-Analysis
Effects of dexmedetomidine as an adjuvant to ropivacaine or ropivacaine alone on duration of postoperative analgesia: A systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
Ropivacaine is a long-acting local anesthetic that is used to treat postoperative pain. Adjuvant use of dexmedetomidine in regional anesthesia may prolong the duration of analgesia. The objective of this systematic review and meta-analysis was to investigate the duration and effect of ropivacaine alone vs. ropivacaine in combination with dexmedetomidine for postoperative analgesia.
METHODS
The PubMed, EMBASE, Web of Science, and Google Scholar databases were searched for randomized controlled trials (RCTs) of ropivacaine alone or ropivacaine in combination with dexmedetomidine for regional anesthesia. The primary outcome was duration of analgesia, defined as the time from onset of the block to the time of the first analgesic request or initial pain report. Secondary outcomes were duration of sensory block, duration of motor block, consumption of sufentanil for analgesia, length of hospital stay, and incidence of postoperative nausea and vomiting.
RESULTS
Eighteen studies with 1148 patients were included. Overall quality of the RCTs, as assessed by the Jadad scale, was high. The meta-analysis demonstrated that ropivacaine combined with dexmedetomidine significantly prolonged the duration of postoperative analgesia from local anesthetics compared to ropivacaine alone (WMD: 4.14h; 95%CI: 3.29~5.0h; P<0.00001; I2 = 99%). There was evidence of high heterogeneity between studies. The duration of sensory and motor block was significantly increased, and consumption of sufentanil for analgesia and the incidence of postoperative nausea and vomiting were significantly reduced in patients who received ropivacaine combined with dexmedetomidine compared to ropivacaine alone. There was no significant difference in length of hospital stay.
CONCLUSIONS
Compared to ropivacaine alone, ropivacaine combined with dexmedetomidine significantly prolonged the duration of postoperative analgesia and sensory and motor block, and reduced consumption of sufentanil for analgesia and the incidence of postoperative nausea and vomiting, across an array of surgeries.
Topics: Humans; Ropivacaine; Dexmedetomidine; Sufentanil; Postoperative Nausea and Vomiting; Randomized Controlled Trials as Topic; Anesthetics, Local; Pain, Postoperative; Analgesia
PubMed: 37819905
DOI: 10.1371/journal.pone.0287296 -
African Journal of Reproductive Health Jan 2023Cesarean sections are the most common operations in the United States and one of the most common worldwide. Using the lowest possible dose of anesthetic that provides... (Meta-Analysis)
Meta-Analysis Review
Cesarean sections are the most common operations in the United States and one of the most common worldwide. Using the lowest possible dose of anesthetic that provides painless delivery with the lowest adverse events is a major concern. We investigated the efficacy and safety of combined ropivacaine and sufentanil by pooling data from relevant studies. We searched PubMed, Web of sciences, Scopus, and Cochrane Library until the end of December 2021 and included all records with data about combined ropivacaine and sufentanil. We used Review Manager to pool data as a mean difference for continuous outcomes or risk ratio for dichotomous outcomes with a 95% confidence interval. Methodological quality was appraised using version one of the Cochrane risks of bias tool. Seven Randomized clinical trials with a total sample size of 730 women were included; the mean age of enrolled parturients ranged from 28 to 35 years. We found that combined sufentanil and ropivacaine were significantly associated with decreased risk of being aware and nervous during CS (presented by Sedation level 1) (RR: 0.05, 95%CI [0.01,0.33], P=0.002), decreased risk of shivering (RR=0.29, 95%CI [0.19,0.44], P<0.00001), nausea (RR=0.62, 95%CI [0.41, 0.92], P=0.02), and vomiting (RR=0.27, 95% CI [0.12, 0.61], P=0.002). However, combined sufentanil and ropivacaine slightly were associated with late-onset of sensory blockade (MD=0.41, 95%CI [0.13, 0.68], P=0.004) and less motor blockade of leg flexion at hip joint presented by Bromage Scale 0 (RR=7.15 95%CI [2.71, 18.86], P<0.0001). Combined ropivacaine and sufentanil were associated with a reduction in visceral pain and lower risks of hypotension, shivering, nausea, and vomiting, compared to isolated ropivacaine, with no difference regarding the incidence of bradycardia. Although Combined ropivacaine and sufentanil were associated with a higher risk of pruritus, the incidence of pruritus was reportedly proportionate with the used dose of sufentanil. However, combined ropivacaine and sufentanil may slightly delay the onset of the sensory blockade to pinprick at T10 with less motor blockade but with a smaller probability for women to be aware and nervous during CS.
Topics: Female; Pregnancy; Humans; Adult; Ropivacaine; Sufentanil; Anesthetics, Local; Cesarean Section; Amides; Vomiting; Nausea; Pruritus; Randomized Controlled Trials as Topic
PubMed: 37584961
DOI: 10.29063/ajrh2023/v27i1.9 -
Current Medical Research and Opinion Nov 2014In epidural analgesia, synthetic opioids increase the potency of amide local anesthetics by modifying their analgesic properties. The purpose of this systematic review... (Meta-Analysis)
Meta-Analysis Review
Efficacy and safety of local anesthetics bupivacaine, ropivacaine and levobupivacaine in combination with sufentanil in epidural anesthesia for labor and delivery: a meta-analysis.
BACKGROUND
In epidural analgesia, synthetic opioids increase the potency of amide local anesthetics by modifying their analgesic properties. The purpose of this systematic review and meta-analysis is to compare the efficacy and safety of bupivacaine with ropivacaine and levobupivacaine in combination with sufentanil (BUPI-, ROPI-, and LBUPI-SUF respectively) in epidural analgesia for labor.
METHODS
A literature search was made in multiple electronic databases for original research papers published between 1995 and 2014. Meta-analyses were based on mean differences between the groups as well as odds ratios where appropriate. Both the fixed effects and random effects models were utilized and heterogeneity was tested with the I(2) index.
RESULTS
Analgesia duration was significantly longer in ROPI-SUF and LBUPI-SUF than in BUPI-SUF administered women with a mean difference (95% CI) of 16.12 (2.56, 29.68); P < 0.03 and 18.02 (9.09, 26.96); P < 0.0001 respectively under a random effects model (REM). Effective analgesia achievement was significantly earlier in the BUPI-SUF than in either the ROPI-SUF (2.61 [1.87, 3.36]; P < 0.00001) or the LBUPI-SUF groups (4.53 [3.66, 5.40]; P < 0.00001) under a fixed effects model (FEM) but not under a REM (I(2 )= 85%). Motor blockade incidence was higher in BUPI-SUF anesthetized patients, although the difference was not statistically significant. A higher incidence of instrumental deliveries was evident in the ROPI-SUF (FEM: 1.68 [1.13, 2.50]; P < 0.02/REM: 1.76 [1.00, 3.11]; P = 0.05) and LBUPI-SUF (FEM: 2.03 [1.07, 3.86]; P < 0.04/REM: 2.03 [1.07, 3.86]; P < 0.04) groups than in the BUPI-SUF group of patients. Inconsistencies in the availability of parametric data and use of slightly varying anesthetic dosages in included studies were important limitations.
CONCLUSION
Whereas significantly longer labor analgesia can be achieved with ROPI-SUF and LBUPI-SUF and ropivacaine is associated with comparatively less motor blockade, labor duration after epidural analgesia has been found to be shorter in BUPI-SUF and there is a low incidence of instrumental delivery.
Topics: Amides; Analgesics, Opioid; Anesthesia, Epidural; Anesthetics, Local; Bupivacaine; Drug Therapy, Combination; Female; Humans; Labor Pain; Levobupivacaine; Pregnancy; Ropivacaine; Sufentanil
PubMed: 25050590
DOI: 10.1185/03007995.2014.946127 -
Turkish Journal of Obstetrics and... Mar 2021To assess the efficacy of all forms of ropivacaine administration for the management of pain and opioid use, specifically in patients undergoing laparoscopic...
To assess the efficacy of all forms of ropivacaine administration for the management of pain and opioid use, specifically in patients undergoing laparoscopic hysterectomy. We searched PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS for relevant clinical trials matching our eligibility criteria. Outcomes of interest included: Pain intensity (measured either by visual analog scale score or by numerical rating scale score), QoR-40 score (Overall quality of recovery tool, designed to measure physical comfort, physical independence, pain, emotional status, and need for support), and the need for opioid rescue. We performed the analysis under the fixed-effects model for homogeneous data and random-effects model for heterogeneous data. Most heterogeneous data were solved by the leave-one-out method, in cases where this was not successful, we then proceeded to conduct at least one subgroup meta-analysis in an attempt to solve heterogeneity. We assessed the risk of bias using Cochrane's risk of bias tool. A total of five clinical trials were included. Regarding the pain score, there was no significant difference between either group [standardized mean difference=-0.17, 95% confidence interval (CI): (-0.56, 0.23); p=0.41]. The analysis of the overall RoQ40 scores favored the ropivacaine group over the control group significantly [mean difference (MD)=17.68, 95% CI: (1.48, 33.87); p<0.001]. Regarding the use of opioids, the analysis revealed no significant difference between either group [MD=-2.57, 95% CI: (-6.62, 1.49); p=0.21]. Ropivacaine administration by any method does not seem to be effective in reducing pain or reducing the need for opioid use after laparoscopic hysterectomy procedures; however, the administration did show a significant improvement in the patient's "overall quality of recovery," as measured using the QoR-40 tool.
PubMed: 33715334
DOI: 10.4274/tjod.galenos.2021.06606 -
European Journal of Anaesthesiology Sep 2023Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively. (Meta-Analysis)
Meta-Analysis
The postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve and field blocks: A systematic review and meta-analysis, with trial sequential analysis.
BACKGROUND
Liposomal bupivacaine is claimed by the manufacturer to provide analgesia for up to 72 h postoperatively.
OBJECTIVES
To compare the postoperative analgesic efficacy of liposomal bupivacaine versus long-acting local anaesthetics for peripheral nerve or field blocks.
DESIGN
A systematic review and meta-analysis with trial sequential analysis.
DATA SOURCES
MEDLINE, Embase and Web of Science, among others, up to June 2022.
ELIGIBILITY CRITERIA
We retrieved randomised controlled trials comparing liposomal bupivacaine versus bupivacaine, levobupivacaine or ropivacaine for peripheral nerve and field blocks after all types of surgery. Our primary endpoint was rest pain score (analogue scale 0 to 10) at 24 h. Secondary endpoints included rest pain score at 48 and 72 h, and morphine consumption at 24, 48 and 72 h.
RESULTS
Twenty-seven trials including 2122 patients were identified. Rest pain scores at 24 h were significantly reduced by liposomal bupivacaine with a mean difference (95% CI) of -0.9 (-1.4 to -0.4), I2 = 87%, P < 0.001. This reduction in pain scores persisted at 48 h and 72 h with mean differences (95% CI) of -0.7 (-1.1 to -0.3), I2 = 82%, P = 0.001 and -0.7 (-1.1 to -0.3), I2 = 80%, P < 0.001, respectively. There were no differences in interval morphine consumption at 24 h ( P = 0.15), 48 h ( P = 0.15) and 72 h ( P = 0.07). The quality of evidence was moderate.
CONCLUSIONS
There is moderate level evidence that liposomal bupivacaine reduces rest pain scores by 0.9 out of 10 units, when compared with long-acting local anaesthetics at 24 hours after surgery, and by 0.7 up to 72 hours after surgery.
Topics: Humans; Anesthetics, Local; Pain, Postoperative; Bupivacaine; Analgesics; Morphine; Peripheral Nerves; Analgesics, Opioid
PubMed: 37038770
DOI: 10.1097/EJA.0000000000001833 -
Knee Surgery, Sports Traumatology,... Mar 2018Many studies have shown that local anesthetics may impede chondrocyte metabolism. However, the influence of a single-dose local anesthetics is controversial. The aim of... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Many studies have shown that local anesthetics may impede chondrocyte metabolism. However, the influence of a single-dose local anesthetics is controversial. The aim of this metaanalysis was to review the literature for studies investigating the cytotoxic effects of single-dose local anesthetics on chondrocytes and cartilage.
METHODS
A comprehensive literature search was performed using established search engines (Medline, Embase) to identify studies, investigating the influence of single-dose local anesthetics on cartilage. The systematic analysis included the influence on histology, cell viability, morphology, and matrix production depending upon dose, exposure time, and type of local anesthetics.
RESULTS
Twelve studies with four different local anesthetics were included in this metaanalysis. Bupivacaine and lidocaine were found to be more chondrotoxic than mepivacaine and ropivacaine. The amount of dead cells increased in a substance-, dose-, and time-dependent process. Osteoarthritic cartilage seems to be more vulnerable compared to intact cartilage. The toxic effects occur first in the superficial cartilage layers and include damage to membrane integrity, mitochondrial DNA, and nuclear changes. There is no study that could show a significant chondrotoxic effect with low concentrations of bupivacaine (0.0625%), ropivacaine (0.1 and 0.2%), and mepivacaine (0.5%).
CONCLUSIONS
The cytotoxicity of local anesthetics on chondrocytes is dependent on dose, time, and type of local anesthetics. Single-dose intra-articular administration of local anesthetics impede chondrocyte metabolism and should be performed only with low concentrations for selected diagnostic purposes and painful joints. The use of lidocaine should be avoided.
LEVEL OF EVIDENCE
II.
Topics: Anesthetics, Local; Cartilage; Cell Survival; Cells, Cultured; Chondrocytes; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans
PubMed: 28289821
DOI: 10.1007/s00167-017-4470-5