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Medicine Aug 2023The transversus abdominis plane (TAP) block is commonly used in surgical practice for postoperative analgesia in abdominal surgery. However, numerous studies have... (Meta-Analysis)
Meta-Analysis
Transversus abdominis plane block versus local anesthetic infiltration for anesthetic effect in peritoneal dialysis catheter insertion: A systematic review and meta-analysis.
BACKGROUND
The transversus abdominis plane (TAP) block is commonly used in surgical practice for postoperative analgesia in abdominal surgery. However, numerous studies have demonstrated that TAP block is also suitable for intraoperative anesthesia of peritoneal dialysis catheter (PDC) insertion, although its efficacy and safety are still controversial. Local anesthetic infiltration (LAI) is currently the most general anesthesia strategy for PDC insertion. Consequently, we conducted this systematic review and meta-analysis to identify which anesthesia strategy is better between TAP block and LAI.
METHODS
A systematic and comprehensive search was conducted on 5 databases, retrieving published and registered randomized controlled trials as of March 10, 2022, comparing the anesthesia effects of TAP block and LAI. The primary outcomes are the visual analogue scale (VAS) pain score of patients at various time points in the surgery. The secondary outcomes are the VAS pain score at rest at 2 and 24 hours postoperatively, intraoperative rescue anesthesia, general anesthesia switching rate, and PD-related complications.
RESULTS
There were 9 trials with 432 patients identified. TAP block was more effective than LAI at reducing intraoperative and postoperative VAS pain scores in patients. Compared to LAI, TAP block significantly reduces the dosage of anesthetics used to rescue anesthesia during surgery, the general anesthesia switching rate, and the incidence of postoperative PD-related complications in patients.
CONCLUSIONS
Our systematic review and meta-analysis proved that TAP block could be used as the primary anesthetic technique for PDC insertion, with superior anesthetic effects to LAI.
Topics: Humans; Anesthetics, Local; Abdominal Muscles; Nerve Block; Peritoneal Dialysis; Catheters; Pain; Pain, Postoperative; Analgesics, Opioid
PubMed: 37543799
DOI: 10.1097/MD.0000000000034517 -
Journal of Pain Research 2023To assess the inhibitory effect of acupuncture on pain symptoms in migraine models, and to further summarize the potential mechanisms of acupuncture in regulating... (Review)
Review
PURPOSE
To assess the inhibitory effect of acupuncture on pain symptoms in migraine models, and to further summarize the potential mechanisms of acupuncture in regulating hyperalgesia in the treatment of migraine.
MATERIALS AND METHODS
Literature search in databases such as China National Knowledge Infrastructure (CNKI), PubMed, and Web of Science (WOS) etc. The quality was evaluated by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) bias risk assessment tool and Collaborative Approach to Meta-analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist. Meta-analyses were performed using Stata 17.0 software.
RESULTS
Twenty-one studies involving 489 animals were identified. The qualitative score ranged from 3 to 9 points. Facial mechanical withdrawal threshold (FMWT) and paw mechanical withdrawal threshold (PMWT) measured by Von Frey filaments were selected as major outcomes, and serum calcitonin gene-related peptide (CGRP) levels measured by ELISA were selected as secondary outcome. Meta-analysis results revealed that true acupuncture (TA) group significantly increased FMWT, PMWT and CGRP compared to model group. TA group showed superior effect in FMWT, PMWT relative to sham acupuncture (SA) group. Subgroup analysis results showed that high risk of bias scores may be responsible for the high heterogeneity of FMWT; additionally, CGRP analysis suggests that acupoint selection and blood collection sites may be sources of heterogeneity. In the treatment of migraine pain symptoms, the underlying mechanism of acupuncture treatment is either the regulation of hyperalgesia and neurotransmitters, or the reduction of inflammatory factors.
CONCLUSION
The results indicate that TA treatment effectively increased the pain threshold and reduced hyperalgesia in migraine rats. In summary, our study highlights the potential of TA as an effective treatment for migraine, but further investigation is required to fully comprehend its mechanism of action and optimize its clinical application.
PubMed: 37521010
DOI: 10.2147/JPR.S422050 -
Heliyon Jul 2023Moxibustion, a traditional Chinese medicine approach, stimulates blood circulation by burning wormwood at acupuncture points and is frequently used in conjunction with... (Review)
Review
BACKGROUND
Moxibustion, a traditional Chinese medicine approach, stimulates blood circulation by burning wormwood at acupuncture points and is frequently used in conjunction with acupuncture for managing knee osteoarthritis. This review aims to compare the effectiveness of moxibustion and acupuncture in the management of knee osteoarthritis.
METHODS
Our team conducted a comprehensive search across several databases: PubMed Central, EMBASE, MEDLINE, the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and the Cochrane Library, covering the timeframe from January 1964 up until April 2022. We implemented a meta-analysis, utilizing a random-effects model, and we've presented the pooled standardized mean difference (SMD) and risk ratio (RR) inclusive of the 95% confidence intervals (CIs), in accordance with the nature of the outcome.
RESULTS
21 studies were included, of which, half were identified as having high risk of bias. The pooled SMD for the pain score was found to be -0.53 (95% CI: -0.91 to -0.15). In-depth analysis focusing on the kind of moxibustion indicated that fire needle moxibustion was more effective in pain reduction (SMD = -0.56; 95% CI: -1.10 to -0.01) compared to alternative moxibustion methods (SMD = -0.47; 95% CI: -0.80 to -0.13). The pooled RR for the success rate in treatment was 1.39 (95% CI: 1.19 to 1.62). Subgroup analysis demonstrated that fire needle moxibustion reported a superior success rate (RR = 1.43; 95% CI: 1.19 to 1.72) in comparison to other types of moxibustion (RR = 1.33; 95% CI: 1.02 to 1.74).
CONCLUSION
Moxibustion, specifically fire needle moxibustion, demonstrated superior effectiveness in managing knee osteoarthritis compared to acupuncture.
PubMed: 37449100
DOI: 10.1016/j.heliyon.2023.e17805 -
Medicine Jul 2023Obesity is a widespread chronic metabolic disease that significantly impairs quality of life. Studies have demonstrated the efficacy of both acupuncture and acupoint... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obesity is a widespread chronic metabolic disease that significantly impairs quality of life. Studies have demonstrated the efficacy of both acupuncture and acupoint catgut embedding (ACE) in the management of obesity. However, the superiority of acupuncture combined with ACE over acupuncture alone remains a subject of controversy. This study aims to elucidate this controversy and provide robust clinical evidence.
METHODS
A comprehensive search of relevant literature from the initiation to July 2022 was carried out in 8 databases (PubMed, EMBASE, Cochrane database, Web of Science, CBM Database, CNKI, Wan-fang Database, and VIP Database). We included randomized controlled trials (RCTs) that investigated the treatment of simple obesity using acupuncture paired with ACE, with acupuncture alone as the control group. The pooled outcomes included body mass index (BMI), body weight (BW), %BF, waist circumference (WC), hip circumferences (HC), waist-to-hip ratio (WHR), therapeutic effective rate (TER), and adverse events. Two independent reviewers performed screening (using EndNote X9) and quality assessment (using the Cochrane Risk of Bias tool) for the included studies. with the software RevMan 5.3 was used to perform pooling of effect sizes. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
RESULTS
A total of 20 trials involving 15 datasets (1616 participants) were included. The findings demonstrated significant improvements in outcome measures when acupuncture was combined with ACE, compared with acupuncture alone (BMI: MD = -1.49 kg/m2, 95% confidence interval [CI] = -1.93 to -1.04, P < .01; BW: MD = -2.38, 95% CI = -3.86 to -0.89, P < .01; %BF: MD = -2.19, 95% CI = -3.23 to -1.15, P < .01; WC: MD = -2.01, 95% CI = -3.66 to -0.35, P < .05; HC: MD = -0.83, 95% CI = -1.64 to -0.02, P < .05; WHR: MD = -0.02, 95% CI = -0.03 to -0.01, P < .01; TER: OR = 2.68, 95% CI = 1.93-3.74, P < .01). Adverse effects were reported in 4 studies.
CONCLUSION SUBSECTIONS
The results of this meta-analysis indicate that acupuncture combined with ACE is superior to acupuncture alone in the treatment of obesity, which is supported by the subgroup analysis. The assessment of efficacy may have been influenced by variations in study quality, potentially amplifying the observed effects. RCTs with larger sample sizes and improved methodological quality are needed to enhance the validity of the findings.
Topics: Humans; Acupuncture Points; Catgut; Acupuncture Therapy; Obesity, Morbid; Obesity
PubMed: 37443503
DOI: 10.1097/MD.0000000000034234 -
The Journal of Pain Oct 2023This systematic review and meta-analysis investigated the effects of non-pharmacological manipulations on experimentally induced secondary hypersensitivity in pain-free... (Review)
Review
This systematic review and meta-analysis investigated the effects of non-pharmacological manipulations on experimentally induced secondary hypersensitivity in pain-free humans. We investigated the magnitude (change/difference in follow-up ratings from pre-manipulation ratings) of secondary hypersensitivity (primary outcome), and surface area of secondary hypersensitivity (secondary outcome), in 27 studies representing 847 participants. Risk of bias assessment concluded most studies (23 of 27) had an unclear or high risk of performance and detection bias. Further, 2 (of 27) studies had a high risk of measurement bias. Datasets were pooled by the method of manipulation and outcome. The magnitude of secondary hypersensitivity was decreased by diverting attention, anodal transcranial direct current stimulation, or emotional disclosure; increased by directing attention toward the induction site, nicotine deprivation, or negative suggestion; and unaffected by cathodal transcranial direct current stimulation or thermal change. Area of secondary hypersensitivity was decreased by anodal transcranial direct current stimulation, emotional disclosure, cognitive behavioral therapy, hyperbaric oxygen therapy, placebo analgesia, or spinal manipulation; increased by directing attention to the induction site, nicotine deprivation, or sleep disruption (in males only); and unaffected by cathodal transcranial direct current stimulation, thermal change, acupuncture, or electroacupuncture. Meta-analytical pooling was only appropriate for studies that used transcranial direct current stimulation or hyperbaric oxygen therapy, given the high clinical heterogeneity among the studies and unavailability of data. The evidence base for this question remains small. We discuss opportunities to improve methodological rigor including manipulation checks, structured blinding strategies, control conditions or time points, and public sharing of raw data. PERSPECTIVE: We described the effects of several non-pharmacological manipulations on experimentally induced secondary hypersensitivity in humans. By shedding light on the potential for non-pharmacological therapies to influence secondary hypersensitivity, it provides a foundation for the development and testing of targeted therapies for secondary hypersensitivity.
PubMed: 37356604
DOI: 10.1016/j.jpain.2023.06.013 -
Advances in Clinical and Experimental... Sep 2023Transcutaneous electrical acupoint stimulation (TEAS) is an emerging therapeutic approach that combines the effects of transcutaneous electrical nerve stimulation (TENS)... (Review)
Review
Transcutaneous electrical acupoint stimulation (TEAS) is an emerging therapeutic approach that combines the effects of transcutaneous electrical nerve stimulation (TENS) with acupuncture point stimulation. Due to its noninvasive nature, it possesses relative advantages over traditional acupuncture and needle-based electrostimulation. Despite the large number of randomized clinical trials (RCTs) describing the effectiveness of TEAS in different applications, its role and mechanism are still not fully understood. The aim of this study was to systematically compare and summarize the latest studies examining a variety of TEAS applications in clinical practice. Databases, including Medline (PubMed), Cochrane Library and Google Scholar were searched without any time restrictions (as of March 2021). The analysis was performed according to the Cochrane Collaboration criteria. Out of 637 studies, only 22 RCTs were selected. Nine studies evaluated the impact of TEAS on nausea and vomiting (NV), showing beneficial effects compared to standard therapy. Eight RCTs examined the effectiveness of TEAS in pain management, reporting pain alleviation described using the visual analog scale (VAS) and lowering of total opioid doses. Improvement of postoperative recovery, in vitro fertilization and pregnancy outcomes, as well as display of cardioprotective properties were found to positively correlate with TEAS. As a noninvasive modality with advantages over classical acupuncture and needle-based electrostimulation, TEAS may be a valuable tool in clinical practice, particularly for pain and NV management. However, considering the methodological quality of the RCTs, rigorous large-scale clinical trials are required to evaluate the clinical utility of this method.
Topics: Pregnancy; Female; Humans; Transcutaneous Electric Nerve Stimulation; Acupuncture Points; Pain Management; Vomiting; Nausea; Pain
PubMed: 37026972
DOI: 10.17219/acem/159703