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Chinese Medical Journal Jun 2017This systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs). (Review)
Review
OBJECTIVE
This systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs).
DATA SOURCES
PubMed, Embase, and the Cochrane Library database were searched for articles that (a) targeted human beings and (b) had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy.
STUDY SELECTION
Thirty-two studies relating to 3409 patients were included in this systematic review.
RESULTS
Based on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a safe and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Horner syndrome.
CONCLUSIONS
RFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules.
Topics: Catheter Ablation; Female; Humans; Male; Thyroid Nodule; Treatment Outcome
PubMed: 28524837
DOI: 10.4103/0366-6999.206347 -
Pain Physician 2015While most trials of thoracic paravertebral nerve blocks (TPVB) for breast surgery show benefit, their effect on postoperative pain intensity, opioid consumption, and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
While most trials of thoracic paravertebral nerve blocks (TPVB) for breast surgery show benefit, their effect on postoperative pain intensity, opioid consumption, and prevention of chronic postsurgical pain varies substantially across studies. Variability may result from use of different drugs and techniques.
OBJECTIVES
To examine the use of TPVB in breast surgery, and to determine which method(s) provide optimal efficacy and safety.
STUDY DESIGN
Mixed-Effects Meta-Analysis.
METHODS
We conducted a systematic review of randomized trials comparing TPVB to no intervention using random-effects models. To evaluate the contributions of various techniques, clinical approaches were included as moderators in mixed-effects models.
RESULTS
A total of 24 randomized controlled trials (RCTs) with 1,822 patients were included. Use of TPVB decreased postoperative pain scores at rest and movement at the first 2, 24, 48, and 72 hours. TPVB modestly decreased intraoperative and postoperative opioid consumption, reduced nausea and vomiting, and shortened hospitalization, but to a probably clinically irrelevant degree. Blocks also appeared to reduce the incidence of chronic postsurgical pain at 6 months. Adding fentanyl to the TPVB improved pain at rest (at 24, 48, and 72 hours) and movement (at 24 and 72 hours). Multilevel blocks provided better postoperative pain control, but only during movement (at 2, 48, and 72 hours). Fewer procedural complications (especially hypotension, epidural spread, and Horner's syndrome) occurred when anatomical landmarks were supplemented with ultrasound guidance.
LIMITATIONS
The number of studies available was limited in the meta-analytic model of incidence of chronic post-surgical pain.
CONCLUSION
TPVB reduces postoperative pain and opioid consumption, and has a limited beneficial effect on the quality of recovery. From all the techniques that were evaluated, only the addition of fentanyl, and performing multilevel blocks were associated with improved acute analgesia. TPVB may reduce chronic postsurgical pain at 6 months.
Topics: Analgesics; Breast; Humans; Mastectomy; Nerve Block; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 26431130
DOI: No ID Found