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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 -
Acta Ophthalmologica Scandinavica Oct 2005Upper spinal manipulation (USM) is frequently used by chiropractors and other health care professionals to treat minor complaints. This systematic review aimed to... (Review)
Review
OBJECTIVE
Upper spinal manipulation (USM) is frequently used by chiropractors and other health care professionals to treat minor complaints. This systematic review aimed to summarize ophthalmological adverse effects of USM recently reported in the medical literature.
METHODS
Five electronic databases were searched for all case reports of ophthalmological adverse effects after USM published between January 1995 and April 2003. No language restrictions were applied. Key data from the primary publications thus located were extracted and critically evaluated.
RESULTS
Fourteen case reports were found. Clinical symptoms and signs were diverse and included loss of vision, ophthalmoplegia, diplopia and Horner's syndrome. The underlying mechanism was arterial wall dissection in most cases. The eventual outcome varied and often included permanent deficits. Causality was frequently deemed likely or certain.
CONCLUSION
Upper spinal manipulation is associated with ophthalmological adverse effects of unknown frequency. Ophthalmologists should be aware of its risks. Rigorous investigations must be conducted to establish reliable incidence figures.
Topics: Complementary Therapies; Databases, Factual; Eye Diseases; Humans; Manipulation, Chiropractic
PubMed: 16187996
DOI: 10.1111/j.1600-0420.2005.00488.x -
The Journal of Pain 2000The purpose of this article was to systematically review the literature in order to assess (1) the current indications for surgical sympathectomy and (2) the incidence...
The purpose of this article was to systematically review the literature in order to assess (1) the current indications for surgical sympathectomy and (2) the incidence of late complications collectively and per indication. All types of upper or lower limb surgical sympathectomies are included. An extensive search strategy looked for controlled trials and observational studies or case series with an english abstract. Out of 1,024 abstracts from MEDLINE and 221 from EMBASE, 135 articles reporting on 22,458 patients and 42,061 procedures (up to april 1998) fulfilled the inclusion criteria. Weighted means were used to control for heterogeneity of data. No controlled trials were found. The main indication was primary hyperhidrosis in 84.3% of the patients. Compensatory hyperhidrosis occurred in 52.3%, gustatory sweating in 32.3%, phantom sweating in 38.6%, and horner's syndrome in 2.4% of patients, respectively, with cervicodorsal sympathectomy, more often after open approach. Neuropathic complications (after cervicodorsal and lumbar sympathectomy) occurred in 11.9% of all patients. Compensatory hyperhidrosis occurred 3 times more often if the indication was palmar hyperhidrosis instead of neuropathic pain (52.3% versus 18.2%), whereas neuropathic complications occurred 3 times more often if the treatment was for neuropathic pain instead of palmar hyperhidrosis (25.2% versus 9.8%). Surgical sympathectomy, irrespective of approach, is accompanied by several potentially disabling complications. Detailed informed consent is recommended when surgical sympathectomy is contemplated.
PubMed: 14622605
DOI: 10.1054/jpai.2000.19408