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Journal of Orthopaedic Surgery and... Sep 2023Rehabilitation post-knee arthroplasty is integral to regaining knee function and ensuring patients' overall well-being. The debate over the relative effectiveness and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rehabilitation post-knee arthroplasty is integral to regaining knee function and ensuring patients' overall well-being. The debate over the relative effectiveness and safety of outpatient versus home-based rehabilitation persists.
METHODS
A thorough literature review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across four databases. Two researchers independently identified eligible studies centering on knee arthroplasty patients undergoing either outpatient or home-based rehabilitation. Study quality was assessed using the Cochrane Collaboration's risk of bias tool, while continuous outcomes were subject to meta-analyses using Stata 17 software.
RESULTS
Our analysis identified no significant differences in primary outcomes, including Range of Motion, Western Ontario and McMaster Universities Arthritis Index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, and the Knee Society Score, between home-based and outpatient rehabilitation across different follow-up points. Adverse reactions, readmission rates, the need for manipulation under anesthesia, reoperation rate, and post-surgery complications were also similar between both groups. Home-based rehabilitation demonstrated cost-effectiveness, resulting in substantial annual savings. Furthermore, quality of life and patient satisfaction were found to be comparable in both rehabilitation methods.
CONCLUSIONS
Home-based rehabilitation post-knee arthroplasty appears as an effective, safe, and cost-efficient alternative to outpatient rehabilitation. Despite these findings, further multicenter, long-term randomized controlled trials are required to validate these findings and provide robust evidence to inform early rehabilitation choices post-knee arthroplasty.
Topics: Humans; Outpatients; Arthroplasty, Replacement, Knee; Quality of Life; Knee Joint; Anesthesia; Multicenter Studies as Topic
PubMed: 37726800
DOI: 10.1186/s13018-023-04160-2 -
Research in Nursing & Health Feb 2023Acupuncture is widely accepted as a therapeutic option for managing depression. However, evidence from clinical trials remains controversial. This review aims to... (Meta-Analysis)
Meta-Analysis
Acupuncture is widely accepted as a therapeutic option for managing depression. However, evidence from clinical trials remains controversial. This review aims to synthesize the best available evidence on the efficacy and safety of acupuncture in managing depression. The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Five databases and the relevant trial registries were searched from the inception to October 2021. Randomized clinical trials of acupuncture for managing depression, published in English, were selected for inclusion. The quality of included studies was assessed using the Cochrane risk of bias tool. Netmeta and dmetar of R packages were used to conduct a network meta-analysis. Twenty-two trials with 2391 participants were eligible and included in the analysis. This review found evidence that electroacupuncture (EA) plus antidepressant achieved superior outcomes compared with the waitlist (standardized mean difference = -8.86, 95% confidence interval: -14.78 to -2.93). The treatment ranking of different interventions in improving depression symptoms indicated that EA plus antidepressant with a probability of 0.8294, followed by manual acupuncture (MA) plus antidepressant (0.6470) and MA (0.5232). Acupuncture, either in isolation or as an adjunct to pharmacological treatment, has clinical benefits and can be considered a safe option for managing depression.
Topics: Humans; Depression; Acupuncture Therapy; Electroacupuncture; Antidepressive Agents
PubMed: 36509453
DOI: 10.1002/nur.22284 -
Journal of Dental Anesthesia and Pain... Aug 2020The aim of the present systematic review was to evaluate and compare the efficacy of warmed and unwarmed local anesthesia solutions in reduction of pain during intraoral... (Review)
Review
BACKGROUND
The aim of the present systematic review was to evaluate and compare the efficacy of warmed and unwarmed local anesthesia solutions in reduction of pain during intraoral injection administration.
METHODS
PubMed, Ovid SP, and Cochrane Central Register of Controlled Trials were searched from publication years 1990 to 2020 with relevant MeSH terms. Studies were screened by titles and abstracts, followed by full-texts evaluation of the included studies.
RESULTS
A total of four studies were included in the systematic review. Outcomes evaluated were subjective and objective pain during administration of the warmed local anesthesia solution in comparison with the unwarmed local anesthesia solution. Among the four studies that evaluated the self-reported pain score, three studies showed significantly lower pain scores associated with warmed local anesthesia. Only two studies evaluated the observed pain score, and both of them reported a significantly lower pain reaction with the warmed local anesthesia solution.
CONCLUSION
Within the limits of this systematic review, warming the local anesthesia solution to body temperature (37℃) before administration seemed to reduce the discomfort during intraoral local anaesthesia administration, and more high-quality studies should be carried out to validate the same.
PubMed: 32934984
DOI: 10.17245/jdapm.2020.20.4.187 -
Gynecologic and Obstetric Investigation 2022In the last years, spinal anesthesia (SA) has been emerging as an alternative to general anesthesia (GA) for the laparoscopic treatment of gynecological diseases, for... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
In the last years, spinal anesthesia (SA) has been emerging as an alternative to general anesthesia (GA) for the laparoscopic treatment of gynecological diseases, for better control of postoperative pain. The aim of the review is to compare the advantages of SA compared to GA.
METHODS
MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until March 2021. Randomized controlled trials (RCTs) and non-randomized studies (NRSs) about women underwent SA and GA for gynecological laparoscopic surgery were analyzed. Relevant data were extracted and tabulated.
RESULTS
The primary outcomes included the evaluation of postoperative pain (described as shoulder pain), postoperative nausea and vomiting, and operative times. One hundred and eight patients were included in RCTs, 58 in NRSs. The qualitative analysis had conflicting results and for the most of parameters (hemodynamic variables, nausea, and postoperative analgesic administration) no statistically significant differences were observed: in the NRSs, contradictory results regarding the postoperative pain in SA and GA groups were reported. Regarding the quantitative analysis, in the RCTs, women who received SA had not significantly lower operative times (relative risk [RR] -4.40, 95% confidence interval [CI] -9.32-0.53) and a lower incidence of vomiting (RR 0.51, 95% CI 0.17-1.55); on the other hand, in the NRS, women who received SA had longer operative times (RR 5.05, 95% CI -0.03-10.14) and more episodes of vomiting (RR 0.56, 95% CI 0.10-2.97) compared to those with GA: anyway, the outcomes proved to be insignificant.
CONCLUSIONS
Current evidence suggests no significant advantages to using SA over GA for laparoscopic treatment of gynecological diseases.
Topics: Anesthesia, General; Anesthesia, Spinal; Female; Humans; Laparoscopy; Pain, Postoperative; Postoperative Nausea and Vomiting
PubMed: 34915508
DOI: 10.1159/000521364 -
Brazilian Journal of Anesthesiology... 2023Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Spinal infusions of either fentanyl or sufentanil have been reported in international reports, articles, and scientific events worldwide. This study aimed to determine whether intrathecal fentanyl or sufentanil offers safety in mortality and perioperative adverse events.
METHODS
MEDLINE (via PubMed), EMBASE, CENTRAL (Cochrane library databases), gray literature, hand-searching, and clinicaltrials.gov were systematically searched. Randomized controlled trials with no language, data, or status restrictions were included, comparing the effectiveness and safety of adding spinal lipophilic opioid to local anesthetics (LAs). Data were pooled using the random-effects models or fixed-effect models based on heterogeneity.
RESULTS
The initial search retrieved 4469 records; 3241 records were eligible, and 3152 articles were excluded after reading titles and abstracts, with a high agreement rate (98.6%). After reading the full texts, 76 articles remained. Spinal fentanyl and sufentanil significantly reduced postoperative pain and opioid consumption, increased analgesia and pruritus. Fentanyl, but not sufentanil, significantly reduced both postoperative nausea and vomiting, and postoperative shivering; compared to LAs alone. The analyzed studies did not report any case of in-hospital mortality related to spinal lipophilic opioids. The rate of respiratory depression was 0.7% and 0.8% when spinal fentanyl or sufentanil was added and when it was not, respectively. Episodes of respiratory depression were rare, uneventful, occurred intraoperatively, and were easily manageable.
CONCLUSION
There is moderate to high quality certainty that there is evidence regarding the safety and effectiveness of adding lipophilic opioids to LAs in spinal anesthesia.
Topics: Humans; Fentanyl; Anesthesia, Spinal; Analgesics, Opioid; Randomized Controlled Trials as Topic; Sufentanil; Anesthetics, Local; Pain, Postoperative
PubMed: 34954261
DOI: 10.1016/j.bjane.2021.10.010 -
International Journal of Surgery... Mar 2023Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture.
AIM
The aim was to compare the risk of complication of neuraxial anaesthesia with that of general anaesthesia in patients undergoing hip fracture surgery.
METHODS
This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered at PROSPERO (CRD42022337384). The study included eligible randomised controlled trials published before February 2022. Data synthesis was performed to compare the differences between general and neuraxial anaesthesia. Meta-regression analysis was performed to investigate the influence of the publication year. A subgroup analysis was performed based on patient age and the anaesthetic technique used. A grading of recommendations, assessment, development and evaluations assessment was performed to assess the quality of each outcome.
RESULTS
Twenty randomised controlled trials and 4802 patients were included. Data synthesis revealed significant higher risk of acute kidney injury in the general anaesthesia group ( P =0.01). There were no significant differences between the two techniques in postoperative short-term mortality ( P =0.34), delirium ( P =0.40), postoperative nausea and vomiting ( P =0.40), cardiac infarction ( P =0.31), acute heart failure ( P =0.34), pulmonary embolism ( P =0.24) and pneumonia ( P =0.15). Subgroup analysis based on patient age and use of sedative medication did not reveal any significant differences. Meta-regression analysis of the publication year versus each adverse event revealed no statistically significant differences.
CONCLUSION
A significantly higher risk of postoperative acute kidney injury was found in patients receiving general anaesthesia. This study revealed no significant differences in terms of postoperative mortality and other complications between general and neuraxial anaesthesia. The results were consistent across the age groups.
Topics: Humans; Postoperative Complications; Anesthesia, General; Hip Fractures; Postoperative Nausea and Vomiting; Anesthesiology; Randomized Controlled Trials as Topic
PubMed: 36912758
DOI: 10.1097/JS9.0000000000000291 -
BMC Anesthesiology Jun 2023Regional anesthesia appears to reduce cancer recurrence, but the optimal anesthesia modality for non-muscle invasive bladder cancer (NMIBC) were still under debate.... (Meta-Analysis)
Meta-Analysis
Effect of regional versus general anesthesia on recurrence of non-muscle invasive bladder cancer: a systematic review and meta-analysis of eight retrospective cohort studies.
BACKGROUND
Regional anesthesia appears to reduce cancer recurrence, but the optimal anesthesia modality for non-muscle invasive bladder cancer (NMIBC) were still under debate. Therefore, we sought to assess the effect of regional and GA only upon the recurrence and long-term prognosis of NMIBC through this meta-analysis.
METHODS
We performed an extensive literature search of PubMed, Embase, Web of Science, the Cochrane Library and China National Knowledge Infrastructure (up to October 30, 2022) to identify eligible articles on the possible impact of different anesthetic modalities for the recurrence rate of NMIBC.
RESULTS
Eight studies comprising 3764 participants, including 2117 subjects with RA and 1647 with GA, were finally enrolled. Cancer recurrence rate was significantly lower in subjects with RA than those with GA (RR 0.84, 95%CI 0.72-0.98, P = 0.03). We didn't detect the differences between GA and RA in the time of recurrence (SMD 2.07, 95% CI -0.49-4.63, P = 0.11) and cancer progression (RR 1.14, 95%CI 0.71-1.84, P = 0.59). Results from subgroup analysis demonstrated that spinal anesthesia could significantly decrease the incidence of cancer recurrence in comparison with general anesthesia (RR 0.80, 95%CI 0.72-0.88, P < 0.001) and high-risk NMIBC patients who received RA tended to have less recurrence (HR 0.55, 95%CI 0.39-0.79, P = 0.001) than those receiving GA.
CONCLUSIONS
RA, especially spinal anesthesia, may be effective in reducing the recurrence rate after transurethral resection of NMIBC. More prospective experimental and clinical studies are needed to validate our findings.
TRIAL REGISTRATION
INPLASY registration INPLASY2022110097.
Topics: Humans; Non-Muscle Invasive Bladder Neoplasms; Prospective Studies; Retrospective Studies; Urinary Bladder Neoplasms; Anesthesia, General
PubMed: 37312019
DOI: 10.1186/s12871-023-02136-7 -
Cureus Oct 2022Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) pose increased morbidity and mortality, especially to elderly patients. The effect of... (Review)
Review
Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) pose increased morbidity and mortality, especially to elderly patients. The effect of anesthesia is debatable. The databases of PubMed, EMBASE, Google Scholar, Cochrane Library and Web of Science were searched from inception until 24 February 2022 to identify randomized-controlled trials (RCTs) studying the effect of depth of anesthesia on POD and POCD primarily. Data on length of hospital stay and mortality were also extracted. Trial sequential analysis was also performed. Seventeen studies were eligible for systematic review and 15 studies of 5392 patients were eligible for meta-analysis. High bispectral index (BIS) favored a reduction in POD and POCD at three months. We found no significant difference between High BIS and Low BIS for mini-mental state exam (MMSE) score and POCD on day 7. However, this did not translate to a significant difference in length of stay and mortality. The data was also underpowered and heterogeneous. Future RCTs should focus on high-risk patients. A standardized methodology of reporting postoperative delirium and cognitive dysfunction is needed to improve comparisons across trials.
PubMed: 36381936
DOI: 10.7759/cureus.30120 -
Brazilian Journal of Anesthesiology... 2023Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of... (Review)
Review
BACKGROUND AND OBJECTIVES
Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs.
METHODS
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: ("regional anesthesia" OR "nerve block") AND ("complications" OR "nerve lesion" OR "nerve damage" OR "nerve injury"). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed.
RESULTS
Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000.
CONCLUSIONS
Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.
Topics: Humans; United States; Financial Stress; Anesthesia, Conduction; Nerve Block
PubMed: 33823209
DOI: 10.1016/j.bjane.2021.02.043 -
BMC Anesthesiology Nov 2023The latest clinical trials have reported conflicting outcomes regarding the effectiveness of xenon anesthesia in preventing postoperative neurocognitive dysfunction;... (Meta-Analysis)
Meta-Analysis
The latest clinical trials have reported conflicting outcomes regarding the effectiveness of xenon anesthesia in preventing postoperative neurocognitive dysfunction; thus, this study assessed the existing evidence. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases from inception to April 9, 2023, for randomized controlled trials of xenon anesthesia in postoperative patients. We included English-language randomized controlled studies of adult patients undergoing surgery with xenon anesthesia that compared its effects to those of other anesthetics. Duplicate studies, pediatric studies, and ongoing clinical trials were excluded. Nine studies with 754 participants were identified. A forest plot revealed that the incidence of postoperative neurocognitive dysfunction did not differ between the xenon anesthesia and control groups (P = 0.43). Additionally, xenon anesthesia significantly shortened the emergence time for time to opening eyes (P < 0.001), time to extubation (P < 0.001), time to react on demand (P = 0.01), and time to time and spatial orientation (P = 0.04). However, the Aldrete score significantly increased with xenon anesthesia (P = 0.005). Postoperative complications did not differ between the anesthesia groups. Egger's test for bias showed no small-study effect, and a trim-and-fill analysis showed no apparent publication bias. In conclusion, xenon anesthesia probably did not affect the occurrence of postoperative neurocognitive dysfunction. However, xenon anesthesia may effectively shorten the emergence time of certain parameters without adverse effects.
Topics: Adult; Humans; Child; Xenon; Postoperative Period; Anesthetics; Anesthesia, Inhalation; Delirium
PubMed: 37946114
DOI: 10.1186/s12871-023-02316-5