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RMD Open Aug 2023Surgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). This review aimed to summarise the available evidence and to propose a...
OBJECTIVE
Surgical denervation has been proposed as a treatment for pain in hand osteoarthritis (OA). This review aimed to summarise the available evidence and to propose a research agenda.
METHODS
A systematic literature search was performed up to September 2022. Two investigators independently identified studies that reported on denervation for OA of the proximal interphalangeal, distal interphalangeal, metacarpophalangeal or carpometacarpal joints. Quality of studies was assessed and study characteristics, patient characteristics, details of the surgical technique and outcomes of the surgery were extracted.
RESULTS
Of 169 references, 17 articles reporting on 384 denervations in 351 patients were selected. Sixteen case series reported positive outcomes with respect to pain, function and patient satisfaction. One non-randomised clinical trial reported no difference in outcome when comparing denervation of the first carpometacarpal (CMC I) joint to trapeziectomy. Adverse events were frequent, with sensory abnormalities occurring the most, followed by the need for revision surgery. All studies had significant risk of bias.
CONCLUSION
Surgical denervation for pain in hand OA shows some promise, but the available evidence does not allow any conclusions of efficacy and higher-quality research is needed. Techniques should be harmonised and more data regarding how denervation compares to current usual care, other denervation methods or placebo in terms of outcomes and adverse events are needed.
Topics: Humans; Carpometacarpal Joints; Denervation; Osteoarthritis; Pain; Patient Satisfaction
PubMed: 37532467
DOI: 10.1136/rmdopen-2023-003134 -
Brazilian Journal of Anesthesiology... 2023This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery.
METHODS
Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations.
RESULTS
Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery.
CONCLUSION
The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block.
PROSPERO REGISTRATION
CRD42022339628 PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339628.
Topics: Humans; Adolescent; Adult; Femoral Nerve; Pain, Postoperative; Randomized Controlled Trials as Topic; Nerve Block; Fascia
PubMed: 37507071
DOI: 10.1016/j.bjane.2023.07.007 -
PloS One 2023The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The patients received percutaneous nephrolithotomy (PCNL) with severe postoperative pain and discomfort. The erector spinae plane block (ESPB), as a new anesthesia method of plane block, has a positive effect on postoperative analgesia. But evidence of ESPB in PCNL is still lacking. The objective of this study was to systematically analyze the postoperative analgesic effect of ESPB in patients receiving PCNL.
METHODS
The literature searching was conducted in PubMed, EMBASE, Cochrane Library and Clinical Trial Database (clinicaltrials.gov). Two independent researchers screened the included studies and extracted data. Meta-analysis was conducted by using the random-effect model with 95% confidence intervals. Chi-squared test with a significance level of 0.1 was utilized to evaluate the heterogeneity of included studies. The subgroup analysis and meta-regression analysis were conducted in studies with high heterogeneity. The publication bias was assessed based on whether there were discrepancies between prospective trial registration and reported protocols.
RESULTS
There were 8 studies involving 456 patients assessing the efficacy of ESPB in reducing postoperative pain score of PCNL compared with no block or other blocks, such as subcutaneous infiltration, general anesthesia or TPVB intrathecal morphine. ESPB was a significantly effective and safe anesthesia method, which not only improved postoperative pain response (MD -1.76; 95% CI -2.57 to -0.94; I 2 = 85%; p<0.01), but also reduced analgesic consumption (MD -16.92; 95% CI -26.25 to -7.59; I 2 = 92.2%; p<0.01) and prolonged the time of first request for postoperative analgesia (MD 93.27; 95% CI 35.79 to 150.75; I 2 = 85.3%; p = 0.001) in patients receiving PCNL without significant postoperative complications (MD 0.80; 95% CI 0.31 to 2.03; I 2 = 0%; p = 0.404).
CONCLUSIONS
Compared with no block or other blocks, the ESPB was a safe and effective anesthesia for patients receiving PCNL.
Topics: Humans; Nephrolithotomy, Percutaneous; Prospective Studies; Anesthesia, Conduction; Analgesics; Pain, Postoperative; Nerve Block; Ultrasonography, Interventional; Analgesics, Opioid
PubMed: 37450461
DOI: 10.1371/journal.pone.0288781 -
Journal of Clinical Anesthesia Sep 2023This systematic review and meta-analysis aimed to assess the superiority of airway nerve blocks versus airway anesthesia without nerve blocks for awake tracheal... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
This systematic review and meta-analysis aimed to assess the superiority of airway nerve blocks versus airway anesthesia without nerve blocks for awake tracheal intubation (ATI).
DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
SETTING
All studies that assessed the superiority of airway anesthesia technique for awake tracheal intubation were searched in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang database, and VIP databases) and trial registry databases from their inception to December 2022.
PATIENTS
Adult patients included in randomized controlled trials comparing airway anesthesia with or without airway nerve blocks for ATI.
INTERVENTIONS
Airway nerve (including superior laryngeal nerve, glossopharyngeal nerve, or recurrent laryngeal nerve) blocks for ATI.
MEASUREMENTS
The primary outcome was the intubation time. Secondary outcomes were quality of intubating conditions (including patient reaction to placement of the flexible scope and tracheal tube, coughing and gagging, and patient satisfaction) and overall complications during ATI.
MAIN RESULTS
Fourteen articles with 658 patients were identified for analysis. When compared with airway anesthesia without nerve blocks, airway nerve blocks significantly reduced intubation time (standardized mean difference [SMD] -2.57, 95% CI -3.59- -1.56, p < 0.00001), improved anesthesia quality of ATI with higher no reaction to placement of the flexible scope and tracheal tube (relative risk [RR] 9.87; 95% CI 4.10-23.75, p < 0.00001), lower cough or gag reflex during intubation (RR 0.35, 95% CI 0.27-0.46, p < 0.00001), higher excellent patient satisfaction rate (RR 1.88, 95% CI 1.05-3.34, p = 0.03), and lower overall complications (RR 0.29, 95% CI 0.19-0.45, p < 0.00001). The overall quality of evidence was moderate.
CONCLUSIONS
Based on current published evidence, airway nerve blocks provide better airway anesthesia quality for ATI with a shorter intubation time, better intubation conditions including higher no reaction to placement of the flexible scope and tracheal tube, lower cough or gag reflex during intubation, higher excellent patient satisfaction, and lower overall complications.
Topics: Adult; Humans; Cough; Wakefulness; Anesthesia, General; Intubation, Intratracheal; Nerve Block
PubMed: 37054484
DOI: 10.1016/j.jclinane.2023.111122 -
Hip International : the Journal of... Sep 2023The use of quadratus lumborum nerve blocks (QLB) for pain control following elective total hip arthroplasty (THA) has increased substantially in recent years. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The use of quadratus lumborum nerve blocks (QLB) for pain control following elective total hip arthroplasty (THA) has increased substantially in recent years. The objective of this systematic review and meta-analysis was to compare outcomes from randomised controlled trials (RCTs) utilising QLBs following elective THA.
METHODS
MEDLINE, EMBASE, and Cochrane databases were searched for RCTs perioperative QLBs for THA. Quantitative synthesis was conducted for pain scores, opioid consumption and adverse events.
RESULTS
A total of 7 RCTs with 429 patients undergoing THA were included. No differences in pain scores were demonstrated between QLBs and control interventions. Subgroup analysis demonstrated no differences between QLBs and sham procedures or active comparators. No differences in postoperative opioid consumption between QLB and control interventions was found. In trials reporting adverse events, they were rare and similar between groups. Overall, the certainty of the evidence was graded as low or very low.
CONCLUSIONS
The current literature suggests that a QLB for THA does not reduce pain or opioid consumption compared to sham or active comparators.
Topics: Humans; Arthroplasty, Replacement, Hip; Analgesics, Opioid; Pain, Postoperative; Nerve Block; Pain Management
PubMed: 35848126
DOI: 10.1177/11207000221111309