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British Journal of Anaesthesia Jul 2024The efficacy of perineural vs intravenous dexamethasone as a local anaesthetic adjunct to increase duration of analgesia could be particular to specific peripheral nerve... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Intravenous versus perineural dexamethasone to prolong analgesia after interscalene brachial plexus block: a systematic review with meta-analysis and trial sequential analysis.
BACKGROUND
The efficacy of perineural vs intravenous dexamethasone as a local anaesthetic adjunct to increase duration of analgesia could be particular to specific peripheral nerve blocks because of differences in systemic absorption depending on the injection site. Given this uncertainty, we performed a systematic review with meta-analysis and trial sequential analysis comparing dexamethasone administered perineurally or intravenously combined with local anaesthetic for interscalene brachial plexus block.
METHODS
Following a search of various electronic databases, we included 11 trials (1145 patients). The primary outcome was the duration of analgesia defined as the time between peripheral nerve block or onset of sensory blockade and the time to first analgesic request or initial report of pain.
RESULTS
The primary outcome, duration of analgesia, was greater in the perineural dexamethasone group, with a mean difference (95% confidence interval) of 122 (62-183) min, I=73%, P<0.0001. Trial sequential analysis indicated that firm evidence had been reached. The quality of evidence was downgraded to low, mainly because of moderate inconsistency and serious publication bias. No significant differences were present for any of the secondary outcomes, except for onset time of sensory and motor blockade and resting pain score at 12 h, but the magnitude of differences was not clinically relevant.
CONCLUSIONS
There is low-quality evidence that perineural administration of dexamethasone as a local anaesthetic adjunct increases duration of analgesia by an average of 2 h compared with intravenous injection for interscalene brachial plexus block. Given the limited clinical relevance of this difference, the off-label use of perineural administration, and the risk of drug crystallisation, we recommend intravenous dexamethasone administration.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO (CRD42023466147).
Topics: Humans; Dexamethasone; Brachial Plexus Block; Analgesia; Pain, Postoperative; Administration, Intravenous; Anesthetics, Local; Brachial Plexus
PubMed: 38782616
DOI: 10.1016/j.bja.2024.03.042 -
EClinicalMedicine Jun 2024General anaesthesia is provided to more than 300 million surgical patients worldwide, every year. It is administered either through total intravenous anaesthesia, using...
BACKGROUND
General anaesthesia is provided to more than 300 million surgical patients worldwide, every year. It is administered either through total intravenous anaesthesia, using only intravenous agents, or through inhalational anaesthesia, using volatile anaesthetic agents. The debate on how this affects postoperative patient outcome is ongoing, despite an abundance of published trials. The relevance of this topic has grown by the increasing concern about the contribution of anaesthetic gases to the environmental impact of surgery. We aimed to summarise all available evidence on relevant patient outcomes with total intravenous anaesthesia versus inhalational anaesthesia.
METHODS
In this systematic review and meta-analysis, we searched PubMed/Medline, Embase and Cochrane Central Register of Controlled trials for works published from January 1, 1985 to August 1, 2023 for randomised controlled trials comparing total intravenous anaesthesia using propofol versus inhalational anaesthesia using the volatile anaesthetics sevoflurane, desflurane or isoflurane. Two reviewers independently screened titles, abstracts and full text articles, and assessed risk of bias using the Cochrane Collaboration tool. Outcomes were derived from a recent series of publications on consensus definitions for Standardised Endpoints for Perioperative trials (StEP). Primary outcomes covered mortality and organ-related morbidity. Secondary outcomes were related to anaesthetic and surgical morbidity. This study is registered with PROSPERO (CRD42023430492).
FINDINGS
We included 317 randomised controlled trials, comprising 51,107 patients. No difference between total intravenous and inhalational anaesthesia was seen in the primary outcomes of in-hospital mortality (RR 1.05, 95% CI 0.67-1.66, 27 trials, 3846 patients), 30-day mortality (RR 0.97, 95% CI 0.70-1.36, 23 trials, 9667 patients) and one-year mortality (RR 1.14, 95% CI 0.88-1.48, 13 trials, 9317 patients). Organ-related morbidity was similar between groups except for the subgroup of elderly patients, in which total intravenous anaesthesia was associated with a lower incidence of postoperative cognitive dysfunction (RR 0.62, 95% CI 0.40-0.97, 11 trials, 3834 patients) and a better score on postoperative cognitive dysfunction tests (standardised mean difference 1.68, 95% CI 0.47-2.88, 9 trials, 4917 patients). In the secondary outcomes, total intravenous anaesthesia resulted in a lower incidence of postoperative nausea and vomiting (RR 0.61, 95% CI 0.56-0.67, 145 trials, 23,172 patients), less emergence delirium (RR 0.40, 95% CI 0.29-0.56, 32 trials, 4203 patients) and a higher quality of recovery score (QoR-40 mean difference 6.45, 95% CI 3.64-9.25, 17 trials, 1835 patients).
INTERPRETATION
The results indicate that postoperative mortality and organ-related morbidity was similar for intravenous and inhalational anaesthesia. Total intravenous anaesthesia offered advantages in postoperative recovery.
FUNDING
Dutch Society for Anaesthesiology (NVA).
PubMed: 38774674
DOI: 10.1016/j.eclinm.2024.102636 -
Medicine May 2024The efficacy of fascia iliaca block (FIB) versus quadratus lumborum block (QLB) remains controversial for pain management of hip arthroplasty. We conduct a systematic... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND
The efficacy of fascia iliaca block (FIB) versus quadratus lumborum block (QLB) remains controversial for pain management of hip arthroplasty. We conduct a systematic review and meta-analysis to explore the influence of FIB versus QLB on the postoperative pain intensity of hip arthroplasty.
METHODS
We have searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through July 2023 for randomized controlled trials assessing the effect of FIB versus QLB on pain control of hip arthroplasty. This meta-analysis is performed using the random-effect model or fixed-effect model based on the heterogeneity.
RESULTS
Four randomized controlled trials and 234 patients were included in the meta-analysis. Overall, compared with QLB for hip arthroscopy, FIB was associated with substantially lower pain scores at 2 hours (mean difference [MD] = -0.49; 95% CI = -0.63 to -0.35; P < .00001) and pain scores at 12 hours (MD = -0.81; 95% CI = -1.36 to -0.26; P = .004), but showed no impact on pain scores at 24 hours (MD = -0.21; 95% CI = -0.57 to 0.15; P = .25), time to first rescue analgesia (standard mean difference = 0.70; 95% CI = -0.59 to 1.99; P = .29), analgesic consumption (MD = -4.80; 95% CI = -16.57 to 6.97; P = .42), or nausea and vomiting (odd ratio = 0.66; 95% CI = 0.32-1.35; P = .25).
CONCLUSIONS
FIB may be better than QLB for pain control after hip arthroplasty, as evidenced by the lower pain scores at 2 and 24 hours.
Topics: Humans; Nerve Block; Randomized Controlled Trials as Topic; Arthroplasty, Replacement, Hip; Pain, Postoperative; Fascia; Pain Measurement; Abdominal Muscles; Pain Management
PubMed: 38758845
DOI: 10.1097/MD.0000000000038247 -
Frontiers in Pharmacology 2023There is no meta-analysis reporting the analgesic effect and safety of bupivacaine in patients undergoing hemorrhoidectomy. This meta-analysis provides quantitative...
There is no meta-analysis reporting the analgesic effect and safety of bupivacaine in patients undergoing hemorrhoidectomy. This meta-analysis provides quantitative evidence of the effect of bupivacaine in hemorrhoidectomy. Studies were searched from PubMed, Embase, the Cochrane Library, and the Web of Science. Standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) with 95% confidence interval (CI) were used as effect indicators. Heterogeneity was assessed using the index, and sensitivity analysis was conducted to determine the effect of the single study on the pooled results. A total of 18 studies were included in this meta-analysis. The pain level at 48 h was lower in the bupivacaine-combined other drug group than in the other drug group (WMD = -0.65, 95% CI: 1.18 to -0.11, and I = 37.50%). Compared to the bupivacaine group, the odds of pruritus (OR = 12.11, 95% CI: 1.49-98.59, and I = 0%) and urinary retention (OR = 4.45, 95% CI: 1.12-17.70, and I = 0%) were higher, and the pain level at 6 h (WMD = -2.13, 95% CI: 3.22 to -1.04, and I = 64.30%), at 12 h (WMD = -1.55, 95% CI: 2.19 to -0.90, and I = 56.10%), and at 24 h (SMD = -1.15, 95% CI: 1.89 to -0.42, and I = 82.5%) were lower in the bupivacaine-combined other drug group. Bupivacaine-combined other drugs had a good analgesic effect after hemorrhoidectomy, but the adverse reactions should be considered.
PubMed: 38751500
DOI: 10.3389/fphar.2023.1331965 -
Scandinavian Journal of Trauma,... May 2024Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pre-hospital endotracheal intubation (ETI) is a sophisticated procedure with a comparatively high failure rate. Especially, ETI in confined spaces may result in higher difficulty, longer times, and a higher failure rate. This study analyses if Helicopter Emergency Medical Services (HEMS) intubation (time-to) success are influenced by noise, light, and restricted space in comparison to ground intubation. Available literature reporting these parameters was very limited, thus the reported differences between ETI in helicopter vs. ground by confronting parameters such as time to secure airway, first pass success rate and Cormack-Lehane Score were analysed.
METHODS
A systematic review and meta-analysis were conducted using PUBMED, EMBASE, Cochrane Library, and Ovid on October 15th, 2022. The database search provided 2322 studies and 6 studies met inclusion and quality criteria. The research was registered with the International Prospective Register of Systematic Reviews (CRD42022361793).
RESULTS
A total of six studies were selected and analysed as part of the systematic review and meta-analysis. The first pass success rate of ETI was more likely to fail in the helicopter setting as compared to the ground (82,4% vs. 87,3%), but the final success rate was similar between the two settings (96,8% vs. 97,8%). The success rate of intubation in literature was reported higher in physician-staffed HEMS than in paramedic-staffed HEMS. The impact of aircraft type and location inside the vehicle on intubation success rates was inconclusive across studies. The meta-analysis revealed inconsistent results for the mean duration of intubation, with one study reporting shorter intubation times in helicopters (13,0s vs.15,5s), another reporting no significant differences (16,5s vs. 16,8s), and a third reporting longer intubation times in helicopters (16,1s vs. 15,0s).
CONCLUSION
Further research is needed to assess the impact of environmental factors on the quality of ETI on HEMS. While the success rate of endotracheal intubation in helicopters vs. on the ground is not significantly different, the duration and time to secure the airway, and Cormack-Lehane Score may be influenced by environmental factors. However, the limited number of studies reporting on these factors highlights the need for further research in this area.
Topics: Intubation, Intratracheal; Humans; Air Ambulances; Emergency Medical Services
PubMed: 38730289
DOI: 10.1186/s13049-024-01213-1 -
Pain Management Nursing : Official... May 2024This systematic review and meta-analysis aimed to determine the effectiveness of virtual reality (VR) in alleviating pain and improving the experience of burn patients...
OBJECTIVES
This systematic review and meta-analysis aimed to determine the effectiveness of virtual reality (VR) in alleviating pain and improving the experience of burn patients during wound care and physical therapy.
DESIGN
A systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase, the Cochrane Database, and the Web of Science.
REVIEW/ANALYSIS METHODS
We searched four electronic databases for randomized controlled trials (RCTs) published from the earliest available date up to March 1, 2022. The primary outcome was worst pain intensity, while secondary outcomes encompassed pain unpleasantness intensity, time spent thinking about pain, and fun experience intensity. Risk of bias was evaluated using the Cochrane Collaboration's tool.
RESULTS
This study included 21 trials. The combined data revealed that the VR group experienced a significant reduction in worst pain intensity, pain unpleasantness intensity, and time spent thinking about pain compared to the control group. Moreover, VR treatment was associated with a significant increase in the fun experience intensity.
IMPLICATIONS FOR NURSING
Virtual reality has the potential value of auxiliary analgesia in burn care, and exploring a more perfect scheme of VR-assisted analgesia is worthwhile.
CONCLUSIONS
The results of this meta-analysis indicate that VR can effectively reduce worst pain intensity, pain unpleasantness intensity, and time spent thinking about pain during wound care and physical therapy for burn patients. Additionally, it enhances fun experience intensity of the treatment period. Therefore, VR shows promise as a valuable complementary pain management intervention for burn patients.
PubMed: 38702259
DOI: 10.1016/j.pmn.2024.03.002 -
Medicine May 2024Despite laparoscopic cholecystectomy (LC) is a commonly performed operation under ambulatory setting, significant postoperative pain is still a major concern. The... (Meta-Analysis)
Meta-Analysis Comparative Study
Ultrasound-guided subcostal approach of transversus abdominis plane block compared with wound infiltration for postoperative analgesia following laparoscopic cholecystectomy: A systematic review and meta-analysis.
BACKGROUND
Despite laparoscopic cholecystectomy (LC) is a commonly performed operation under ambulatory setting, significant postoperative pain is still a major concern. The ultrasound-guided subcostal approach of transversus abdominis plane (sTAP) blocks and wound infiltration (WI) are both widely practiced techniques to reduce postoperative pain in patients undergoing LC. Although these methods have been shown to relieve postoperative pain effectively, the relative analgesic efficacy between ultrasound-guided sTAP blocks and WI is not well known.
METHODS
We searched PubMed, EMBASE, and CENTRAL to identify all randomized controlled trials (RCTs) comparing ultrasound-guided sTAP block versus WI for postoperative pain control in adult patients undergone LC. The search was performed until May 2023. Primary outcome was defined as 24-hour cumulative opioid consumption. Secondary outcomes were postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV).
RESULTS
Finally, 6 RCTs were included, and data from 314 participants were retrieved. Postoperative 24-hour opioid consumption was significantly lower in ultrasound-guided sTAP group than in the WI group with a mean difference of -6.67 (95% confidence interval: -9.39 to - 3.95). The ultrasound-guided sTAP group also showed significantly lower pain scores. Incidence of PONV did not significantly differ between the 2 groups.
CONCLUSIONS
We conclude that there is low to moderate evidence to advocate that ultrasound-guided sTAP block has better analgesic effects than WI in patients undergoing LC. Further trials are needed with robust methodology and clearly defined outcomes.
Topics: Humans; Pain, Postoperative; Nerve Block; Cholecystectomy, Laparoscopic; Ultrasonography, Interventional; Abdominal Muscles; Randomized Controlled Trials as Topic; Analgesics, Opioid
PubMed: 38701299
DOI: 10.1097/MD.0000000000038044 -
Pharmaceuticals (Basel, Switzerland) Apr 2024The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on... (Review)
Review
The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on PubMed, Scopus, and Web of Science to identify studies on postoperative pain control in oral cancer. The review included open-access research, investigations into pain management, randomized clinical trials, retrospective studies, case-control studies, prospective studies, English-written studies, and full-text publications. Exclusion criteria included animal studies; in vitro studies; off-topic studies; reviews, case reports, letters, or comments; and non-English language. Three reviewers independently accessed databases and assigned a quality rating to the chosen articles. The review explores postoperative pain management in oral cancer patients; highlighting persistent opioid use; the efficacy of adjuvant drugs, such as gabapentin; and a multimodal approach. It emphasizes the need for personalized pain management, recognizing individual pain perception and tailoring interventions. Integrating pharmacological and non-pharmacological strategies is crucial for comprehensive pain management. The review also serves as a guide for future research, emphasizing the need for standardized methodologies and diverse participant populations.
PubMed: 38675500
DOI: 10.3390/ph17040542 -
British Journal of Anaesthesia Jul 2024Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence... (Meta-Analysis)
Meta-Analysis Comparative Study Review
BACKGROUND
Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence is lower when propofol is used for maintenance of anaesthesia compared with sevoflurane, although this is not clear.
METHODS
This meta-analysis compared postoperative pain following maintenance of anaesthesia with propofol or sevoflurane in paediatric surgeries. PubMed Medline, Embase, Scopus, Web of Science and Cochrane Library were searched for randomised controlled trials (RCTs) that compared postoperative pain between sevoflurane and propofol anaesthesia in children. After quality assessment, a meta-analysis was carried out using bias-adjusted inverse heterogeneity methods, heterogeneity using I and publication bias using Doi plots.
RESULTS
In total, 13 RCTs with 1174 children were included. The overall synthesis suggested nearly two-fold higher odds of overall postoperative pain in the sevoflurane group compared with the propofol group (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.12-3.15, I=58.2%). Further, children in the sevoflurane group had higher odds of having higher pain scores (OR 3.18, 95% CI 1.83-5.53, I=20.9%), and a 60% increase in the odds of requiring postoperative rescue analgesia compared with propofol (OR 1.60, 95% CI 0.89-2.88, I=58.2%).
CONCLUSIONS
Children maintained on inhalational sevoflurane had higher odds of postoperative pain compared with those maintained on propofol. The results also suggest that sevoflurane is associated with higher odds of needing postoperative rescue analgesia compared with propofol.
REGISTRATION
The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023445913.
Topics: Humans; Sevoflurane; Propofol; Pain, Postoperative; Child; Anesthetics, Inhalation; Anesthetics, Intravenous; Child, Preschool; Randomized Controlled Trials as Topic
PubMed: 38670899
DOI: 10.1016/j.bja.2024.03.022 -
Frontiers in Neurology 2024Acupuncture, acknowledged as a potent non-pharmacological therapy, is frequently employed to alleviate pain. Despite its widespread use, there has been a lack of...
OBJECTIVE
Acupuncture, acknowledged as a potent non-pharmacological therapy, is frequently employed to alleviate pain. Despite its widespread use, there has been a lack of overarching bibliometric analysis of clinical research on acupuncture analgesia. We aimed to summarize current patterns, hotspots, and development trends in this field through bibliometric analysis.
METHODS
This study evaluates academic publications retrieved from the Web of Science database (2010.01-2023.09) concerning acupuncture analgesia in clinical settings. All primary and secondary studies on humans were included. To track global developmental trends, we employed several software for analyzing annual publication volumes, countries/regions, institutions, authors, cited authors, journals, cited journals, references, and keywords and to draw collaborative networks and reference co-citation network maps.
RESULTS
The final search encompassed 7,190 relevant studies, including 1,263 randomized controlled trials (RCTs) and 1,293 systematic reviews and meta-analyses. The results indicated a gradual increase in the number of annual publications on acupuncture analgesia in clinical practice. Among countries and institutions, China (2,139) and Chengdu University of Traditional Chinese Medicine (258) ranked first. Liang FR (89 articles) was the most prolific author, while MacPherson H (604) was the most cited author. MEDICINE (455) was the most productive journal, and Pain (2,473/0.20) ranked first in both the frequency and centrality of cited journals. Notably, the most frequently cited reference was a systematic review of individual patient data on acupuncture carried out for chronic pain that was published by Vickers Andrew J in 2012 (156). Burst analysis identified frontier research areas for 2010-2020, encompassing network meta-analysis, case reports, dry needling, lumbar disc herniation, cancer, post-herpetic neuralgia, insomnia, and bibliometric analysis.
CONCLUSION
This study outlines current trends and potential future research hotspots in clinical acupuncture analgesia over the past decade. Findings emphasize the necessity for enhanced international collaboration to improve research output and translation.
PubMed: 38665996
DOI: 10.3389/fneur.2024.1368988