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The Cochrane Database of Systematic... Jul 2015Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body. It involves infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective, safer anaesthesia for cataract surgery than retrobulbar block.
OBJECTIVES
The objective of this review was to assess the effects of peribulbar anaesthesia (PB) compared to retrobulbar anaesthesia (RB) on pain scores, ocular akinesia, patient acceptability and ocular and systemic complications.
SEARCH METHODS
In the previous version of our review, we searched the databases until December 2007. In this updated version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (March 2015); MEDLINE (1960 to March 2015); and EMBASE (1980 to March 2015).
SELECTION CRITERIA
We included randomized controlled clinical trials comparing peribulbar anaesthesia and retrobulbar anaesthesia for cataract surgery.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed trial quality and extracted data. We contacted trial authors for additional information, study methodology and missing data. We carried out a descriptive narrative of results as the included studies used varied methods for reporting the outcomes. We performed a subgroup analysis for globe akinesia.
MAIN RESULTS
We included six trials involving 1438 participants. Three of the six trials had adequate sequence generation while all the trials had unclear allocation concealment There was no evidence of any difference in pain perception during surgery with either retrobulbar or peribulbar anaesthesia. Both were largely effective. There was no evidence of any difference in complete akinesia or the need for further injections of local anaesthetic. Conjunctival chemosis was more common after peribulbar block (relative risk (RR) 2.11, 95% confidence interval (CI) 1.46 to 3.05) and lid haematoma was more common after retrobulbar block (RR 0.36, 95% CI 0.15 to 0.88). Retrobulbar haemorrhage was uncommon and occurred only once, in a patient who had a retrobulbar block.
AUTHORS' CONCLUSIONS
There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery measuring acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare for both types of block.
Topics: Anesthesia, Local; Cataract Extraction; Humans; Nerve Block; Pain Measurement; Randomized Controlled Trials as Topic
PubMed: 26133124
DOI: 10.1002/14651858.CD004083.pub3 -
The Cochrane Database of Systematic... May 2017Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various nerve blocks with local anaesthetic agents have been used to reduce pain after hip fracture and subsequent surgery. This review was published originally in 1999 and was updated in 2001, 2002, 2009 and 2017.
OBJECTIVES
This review focuses on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anaesthesia for hip fracture surgery. We undertook the update to look for new studies and to update the methods to reflect Cochrane standards.
SEARCH METHODS
For the updated review, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8), MEDLINE (Ovid SP, 1966 to August week 1 2016), Embase (Ovid SP, 1988 to 2016 August week 1) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO, 1982 to August week 1 2016), as well as trial registers and reference lists of relevant articles.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) involving use of nerve blocks as part of the care provided for adults aged 16 years and older with hip fracture.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed new trials for inclusion, determined trial quality using the Cochrane tool and extracted data. When appropriate, we pooled results of outcome measures. We rated the quality of evidence according to the GRADE Working Group approach.
MAIN RESULTS
We included 31 trials (1760 participants; 897 randomized to peripheral nerve blocks and 863 to no regional blockade). Results of eight trials with 373 participants show that peripheral nerve blocks reduced pain on movement within 30 minutes of block placement (standardized mean difference (SMD) -1.41, 95% confidence interval (CI) -2.14 to -0.67; equivalent to -3.4 on a scale from 0 to 10; I = 90%; high quality of evidence). Effect size was proportionate to the concentration of local anaesthetic used (P < 0.00001). Based on seven trials with 676 participants, we did not find a difference in the risk of acute confusional state (risk ratio (RR) 0.69, 95% CI 0.38 to 1.27; I = 48%; very low quality of evidence). Three trials with 131 participants reported decreased risk for pneumonia (RR 0.41, 95% CI 0.19 to 0.89; I = 3%; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 5 to 72; moderate quality of evidence). We did not find a difference in risk of myocardial ischaemia or death within six months, but the number of participants included was well below the optimal information size for these two outcomes. Two trials with 155 participants reported that peripheral nerve blocks also reduced time to first mobilization after surgery (mean difference -11.25 hours, 95% CI -14.34 to -8.15 hours; I = 52%; moderate quality of evidence). One trial with 75 participants indicated that the cost of analgesic drugs was lower when they were given as a single shot block (SMD -3.48, 95% CI -4.23 to -2.74; moderate quality of evidence).
AUTHORS' CONCLUSIONS
High-quality evidence shows that regional blockade reduces pain on movement within 30 minutes after block placement. Moderate-quality evidence shows reduced risk for pneumonia, decreased time to first mobilization and cost reduction of the analgesic regimen (single shot blocks).
Topics: Aged; Aged, 80 and over; Anesthetics, Local; Confusion; Female; Hip Fractures; Humans; Male; Movement; Myocardial Infarction; Nerve Block; Pain Management; Pain Measurement; Pain, Postoperative; Peripheral Nerves; Pneumonia; Randomized Controlled Trials as Topic; Time Factors
PubMed: 28494088
DOI: 10.1002/14651858.CD001159.pub2 -
Scandinavian Journal of Pain Oct 2021Erector Spinae Plane Block (ESPB) was described by Forero in 2016. ESPB is currently widely used in acute postoperative pain management. The benefits of ESPB include... (Review)
Review
Erector Spinae Plane Block (ESPB) was described by Forero in 2016. ESPB is currently widely used in acute postoperative pain management. The benefits of ESPB include simplicity and efficacy in various surgeries. The aim of this review was to conduct a comprehensive overview of available evidence on erector spinae plane block in clinical practice. We included randomized controlled trials and systematic reviews reporting the ESPB in human subjects. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-one articles including five systematic reviews and 16 randomized controlled trials were included and analyzed. ESPB appears to be an effective, safe, and simple method for acute pain management in cardiac, thoracic, and abdominal surgery. The incidence of side effects has been reported to be rare. A critical issue is to make sure that new evidence is not just of the highest quality, in form of well powered and designed randomized controlled trials but also including a standardized and homogeneous set of indicators that permit to assess the comparative effectiveness of the application of ESPB in acute interventional pain management.
Topics: Humans; Nerve Block; Pain Management; Pain, Postoperative; Paraspinal Muscles; Research Design
PubMed: 33984888
DOI: 10.1515/sjpain-2020-0171 -
BMJ Open Jul 2020To assess the effectiveness of radiofrequency denervation (RD) of lumbosacral anatomical targets for the management of chronic back pain. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To assess the effectiveness of radiofrequency denervation (RD) of lumbosacral anatomical targets for the management of chronic back pain.
DESIGN
Systematic review and meta-analysis of randomised controlled trials (RCTs).
METHODS
A database search (Medline, Medline in Process, Embase, CINHAL and the Cochrane library) was conducted from January 2014 to April 2019 for placebo or no-treatment controlled trials of RD for the management of chronic back pain. Included trials were quality assessed using the Cochrane Risk-of-Bias Tool and the quality of outcomes assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Meta-analysis was conducted to calculate mean difference (MD) in post-treatment Pain Score.
RESULTS
Nineteen RCTs were included in the review. There appears to be short-term pain relief (1-3 months) provided by RD of the sacroiliac joint (five trials, MD -1.53, CI -2.62 to 0.45) and intervertebral discs (four trials, MD -0.98, CI -1.84 to 0.12), but the placebo effect is large and additional intervention effect size is small (<1 on an 11 point (0-10) Pain Scale). Longer-term effectiveness (>6 months) is uncertain.
CONCLUSIONS
RD of selected lumbosacral targets appears to have a small, short-term, positive effect for the management of patients with chronic back pain. However, the quality of evidence for the majority of outcomes is low or very low quality and there is still a degree of uncertainty, particularly around the duration of effect.
Topics: Humans; Low Back Pain; Radiofrequency Therapy
PubMed: 32699129
DOI: 10.1136/bmjopen-2019-035540 -
The Journal of Headache and Pain Dec 2017Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional... (Review)
Review
BACKGROUND
Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation.
METHODS
Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions.
RESULTS
Eighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations.
CONCLUSIONS
Overall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings.
Topics: Catheter Ablation; Cluster Headache; Electric Stimulation Therapy; Facial Pain; Humans; Migraine Disorders; Sphenopalatine Ganglion Block; Trigeminal Neuralgia
PubMed: 29285576
DOI: 10.1186/s10194-017-0826-y -
Open Heart 2014The objective of this study is to evaluate the efficacy and safety of renal denervation in patients with resistant hypertension.
OBJECTIVE
The objective of this study is to evaluate the efficacy and safety of renal denervation in patients with resistant hypertension.
METHODS
We searched MEDLINE and EMBASE for studies that evaluated the use of catheter-based renal sympathetic denervation compared to a control group and reported blood pressure results at follow-up. Data was extracted from relevant studies and pooled estimates for blood pressure were determined using the inverse variance method for meta-analysis with mean difference.
RESULTS
We identified 12 studies (three randomised controlled trials (n=688), eight prospective observational studies (n=478) and one observational study with matched controls (n=310)). Data from SYMPLICITY HTN-3, the only high-quality blinded randomised control trial suggests that there is no significant difference in change in systolic (-2.30 95% CI -6.90 to 2.30 mm Hg) or diastolic (-1.96 95% CI -4.98 to 1.06 mm Hg) blood pressure at 6 months. The pooled data from two unblinded trials of lower quality showed significant reduction in change in systolic (-27.36 95% CI -37.08 to -24.61 mm Hg) and diastolic blood pressure (-9.62 95% CI -14.51 to -4.72 mm Hg). In terms of safety, SYMPLICITY HTN-3 found no significant differences between treatment and control group in terms of death, myocardial infarction, new onset renal disease, stroke and hypertensive emergencies.
CONCLUSIONS
In conclusion, while poor quality unblinded studies provide evidence that renal denervation using catheter-based systems is effective in reducing systolic and diastolic blood pressure in resistant hypertension, the largest randomised controlled trial to date (SYMPLICITY HTN-3) failed to demonstrate any benefit.
PubMed: 25332808
DOI: 10.1136/openhrt-2014-000092 -
British Journal of Anaesthesia Feb 2017The increased popularity of paravertebral block (PVB) can be attributed to its relative safety and comparable efficacy when compared with epidural analgesia. It has thus... (Meta-Analysis)
Meta-Analysis Review
The increased popularity of paravertebral block (PVB) can be attributed to its relative safety and comparable efficacy when compared with epidural analgesia. It has thus been recommended for open cholecystectomy and other less painful surgeries such as inguinal herniorraphy and appendectomy. We performed a systematic review of PVB in paediatric abdominal conditions to assess its clinical efficacy and side effects compared with other analgesic therapies.A search of Medline, Embase, and Web of Science and hand-searching references from inception date to May 2016 was done. Relevant studies were randomized clinical trials in patients 0-18 years old comparing PVB (single shot or continuous catheter) with any comparator and analgesic medication. Pain scores, rescue analgesia and adverse events were compared.The systematic reviews identified six trials enrolling 358 paediatric patients. PVB medications included bupivacaine, ropivacaine, lidocaine, and fentanyl. Surgical procedures included inguinal herniorraphy, cholecystectomy, and appendectomy. The standardized mean difference in early pain scores favoured PVB: 0.85 [95% confidence interval (CI) 0.12-1.58] at 4-6 h and 0.64 (95% CI 0.28-1.00) at 24 h. One study reported a reduced length of stay. Parental [odds ratio (OR) 5.12 (95% CI 2.59-10.1)] and surgeon [OR 6.05 (95% CI 2.25-16.3)] satisfaction were higher in those receiving a PVB. No major complications occurred with a PVB.PVB resulted in minimally improved pain scores for up to 24 h after surgery, reduced rescue analgesia requirements, and increased surgeon and parental satisfaction. PVB is a good alternative to caudal and ilioinguinal block in paediatric abdominal surgery.
Topics: Abdomen; Adolescent; Child; Child, Preschool; Humans; Nerve Block; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 28100519
DOI: 10.1093/bja/aew387 -
Journal of Clinical Hypertension... Dec 2022In recent years, catheter-based renal denervation (RDN) has emerged as a promising instrumental therapy for hypertension. The interruption of sympathetic nervous system... (Meta-Analysis)
Meta-Analysis
In recent years, catheter-based renal denervation (RDN) has emerged as a promising instrumental therapy for hypertension. The interruption of sympathetic nervous system was regarded as a possible mechanism for RDN regulating blood pressure. While the results reflected by renin-angiotensin-aldosterone system (RAAS), catecholamines and electrolytes remained inconsistent and was never systematically assessed. Pubmed, Embase, and Web of Science were comprehensively searched from inception to September 5, 2021. Studies that evaluated the effects of RDN on RAAS, catecholamines, and electrolytes were identified. Primary outcomes were changes in RAAS hormones after RDN, and secondary outcomes involved changes in plasma norepinephrine, serum, and urinary sodium and potassium. Out of 6391 retrieved studies, 20 studies (two randomized controlled studies and 18 observational studies) involving 771 persons were eventually included. Plasma renin activity had a statistically significant reduction after RDN (0.24 ng/mL/h, 95% CI 0.04 to 0.44, P = .02). While no significant change was found regarding plasma aldosterone (1.53 ng/dL, 95% CI -0.61 to 3.67, P = .16), norepinephrine (0.42 nmol/L, 95% -0.51 to 1.35, P = 0.38), serum sodium and potassium (0.16 mmol/L, 95% CI -0.17 to 0.49, P = .34; -0.02 mmol/L, 95% CI -0.09 to 0.04, P = .48, respectively), and urinary sodium and potassium (3.95 mmol/24 h, 95% CI -29.36 to 37.26, P = .82; 10.22 mmol/24 h, 95% CI -12.11 to 32.54, P = .37, respectively). In conclusion, plasma renin activity significantly decreased after RDN, while no significant change was observed in plasma aldosterone, plasma norepinephrine, and serum and urinary electrolytes.
Topics: Humans; Catecholamines; Hypertension; Research Design; Potassium; Sodium
PubMed: 36321724
DOI: 10.1111/jch.14590 -
Anaesthesia Sep 2015We systematically reviewed peripheral nerve blockade guided by ultrasound versus electrical stimulation. We included 26 comparisons in 23 randomised controlled trials of... (Meta-Analysis)
Meta-Analysis Review
We systematically reviewed peripheral nerve blockade guided by ultrasound versus electrical stimulation. We included 26 comparisons in 23 randomised controlled trials of 2125 participants. Ultrasound reduced the rate of pain during the procedure, relative risk (95% CI) 0.60 (0.41-0.89), p = 0.01. Ultrasound with or without electrical stimulation reduced the rate of analgesic or anaesthetic rescue versus electrical stimulation alone, relative risk (95% CI) 0.40 (0.29-0.54) and 0.29 (0.16-0.52), respectively, p < 0.0001 for both. The rate of rescue was unaffected by the addition of electrical stimulation to ultrasound, relative risk (95% CI) 1.07 (0.54-2.10), p = 0.85. Ultrasound, with or without electrical stimulation, reduced the pooled rate of vascular puncture, relative risk (95% CI) 0.23 (0.15-0.37), p < 0.0001. There was no difference in the rate of postoperative neurological side-effects, relative risk (95% CI) 0.76 (0.53-1.09), p = 0.13.
Topics: Electric Stimulation; Humans; Nerve Block; Peripheral Nerves; Ultrasonography, Interventional
PubMed: 25989611
DOI: 10.1111/anae.13098