-
Chinese Medical Journal Mar 2020Labor is a complex process and labor pain presents challenges for analgesia. Epidural analgesia (EA) has a well-known analgesic effect and is commonly used during labor....
OBJECTIVE
Labor is a complex process and labor pain presents challenges for analgesia. Epidural analgesia (EA) has a well-known analgesic effect and is commonly used during labor. This review summarized frequently encountered and controversial problems surrounding EA during labor, including the labor process and maternal intrapartum fever, to build knowledge in this area.
DATA SOURCES
We searched for relevant articles published up to 2019 in PubMed using a range of search terms (eg, "labor pain," "epidural," "analgesia," "labor process," "maternal pyrexia," "intrapartum fever").
STUDY SELECTION
The search returned 835 articles, including randomized control trials, retrospective cohort studies, observational studies, and reviews. The articles were screened by title, abstract, and then full-text, with a sample independently screened by two authors. Thirty-eight articles were included in our final analysis; 20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.
RESULTS
Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery. Early initiation following an analgesia request was preferred. However, it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens. There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.
CONCLUSIONS
Early EA (cervical dilation ≥1 cm) does not increase the risk for cesarean section. Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes. The association between EA and maternal pyrexia remains controversial, but pyrexia is more common with EA than without. A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.
Topics: Analgesia, Epidural; Cesarean Section; Fever; Humans; Prospective Studies; Retrospective Studies
PubMed: 32032081
DOI: 10.1097/CM9.0000000000000646 -
PloS One 2022Remifentanil patient-controlled analgesia (rPCA) and epidural analgesia (EA) has been used for pain relief in labor. We aimed to evaluate the efficacy and safety of rPCA... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Remifentanil patient-controlled analgesia (rPCA) and epidural analgesia (EA) has been used for pain relief in labor. We aimed to evaluate the efficacy and safety of rPCA versus EA in labor, to provide evidence support for clinical analgesia and pain care.
METHODS
We searched PubMed, EMBASE, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu databases for RCTs comparing rPCA and EA in labor until February 15, 2022. Two researchers independently screened literature and extracted data. RevMan 5.3 software was used for data analysis.
RESULTS
A total of 10 RCTs involving 3086 parturients were enrolled, 1549 parturients received rPCA and 1537 received EA. Meta-analysis indicated that the incidence of intrapartum maternal fever within 1 hour of labor analgesia (OR = 0.43, 95%CI: 0.30~0.62), after 1 hour of labor analgesia (OR = 0.42, 95%CI: 0.20~0.90) in the rPCA was significantly less than that of EA (all P<0.05). The incidence of respiratory depression (OR = 3.56, 95%CI: 2.45~5.16, P<0.001) in the rPCA was significantly higher than that of EA. There were no significant differences in the incidence of Apgar scores<7 at 5 minutes (OR = 1.18, 95%CI: 0.71~1.96, P = 0.53), the patients' satisfaction of pain relief during labor analgesia (SMD = 0.03, 95%CI: -0.40~0.46, P = 0.90) between rPCA and EA (all P>0.05).
CONCLUSION
rPCA can be an optional alternative to EA with similar pain relief and less risk of intrapartum maternal fever. However, rPCA was associated with increased risk of respiratory depression. Future studies with rigorous design and larger sample size are needed to provide more reliable evidences for clinical rPCA and EA use.
Topics: Pregnancy; Female; Humans; Remifentanil; Analgesia, Epidural; Analgesics, Opioid; Labor Pain; Analgesia, Obstetrical; Analgesia, Patient-Controlled
PubMed: 36534641
DOI: 10.1371/journal.pone.0275716 -
Journal of Midwifery & Women's Health Jan 2023Freedom of movement has been identified as a key issue for pregnant individuals during the birthing process, even if they opt for epidural analgesia, which has relegated... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Freedom of movement has been identified as a key issue for pregnant individuals during the birthing process, even if they opt for epidural analgesia, which has relegated people to more static positions during birth for many years. The aims of this systematic review were to evaluate the influence of mobility and positional changes on perinatal and neonatal outcomes in people in labor with epidural analgesia, describe the range of movement interventions used during the first and second stage of labor, and describe the level of motor blockade among people with low-dose epidural analgesia.
METHODS
Bibliographic databases (Web of Science, Cochrane, CINAHL) were consulted from December 2020 to January 2021. The articles selected were clinical trials and observational or analytical studies, the subject of which was mobilization during labor in people with epidural analgesia. The outcome measures were mode of birth, duration of labor, and extrauterine adaptation after birth. A narrative synthesis was used to describe the types of movements interventions employed during the stages of labor and the level of motor blockade among people with low-dose epidural analgesia.
RESULTS
Ten articles were selected (8 clinical trials, one cross-sectional study, and one quasiexperimental study), with a total sample of 6086 individuals. A meta-analysis showed nonsignificant results between groups for mode of birth (relative risk [RR], 1.00; 95% CI, 0.87-1.14), duration of labor (RR, 1.64; 95% CI, -34.57 to 37.86), and extrauterine adaptation after birth (RR, 0.86; 95% CI, 0.39-1.93). There was heterogeneity among studies in the type of movement interventions used during the first and second stage of labor.
DISCUSSION
Although no clear benefit was observed for mobilization in epidural labor, no detrimental effects were found either, so perinatal care providers should encourage mobilization if the laboring person so desires, throughout the entire childbirth process.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Analgesia, Epidural; Cesarean Section; Cross-Sectional Studies; Analgesia, Obstetrical; Analgesics; Labor Stage, Second
PubMed: 36504479
DOI: 10.1111/jmwh.13446 -
Pain Physician May 2023Thoracotomy is associated with severe postoperative pain. Effective management of acute pain after thoracotomy may reduce complications and chronic pain. Epidural... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Thoracotomy is associated with severe postoperative pain. Effective management of acute pain after thoracotomy may reduce complications and chronic pain. Epidural analgesia (EPI) is considered the gold standard for postthoracotomy analgesia; however, it is associated with complications and limitations. Emerging evidence suggests that an intercostal nerve block (ICB) has a low risk of severe complications. Anesthetists will benefit from a review that assesses the advantages and disadvantages associated with ICB and EPI in thoracotomy.
OBJECTIVES
This meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of ICB and EPI for pain treatment after thoracotomy.
STUDY DESIGN
Systematic review.
METHODS
This study was registered in the International Prospective Register of Systematic Reviews (CRD42021255127). Relevant studies were searched for in PubMed, Embase, Cochrane, and Ovid databases. Primary (postoperative pain at rest and during cough) and secondary (nausea and vomiting, morphine consumption, and length of hospital stay) outcomes were analyzed. The standard mean difference for continuous variables and the risk ratio for dichotomous variables were calculated.
RESULTS
Nine randomized controlled studies with a total of 498 patients who underwent thoracotomy were included. The results of the meta-analysis demonstrated no statistically significant differences between the 2 methods in terms of the Visual Analog Scale scores for pain at 6-8, 12-15, 24-25, and 48-50 hours at rest and at 24 hours during coughing after surgery. There were no significant differences in nausea and vomiting, morphine consumption, or length of hospital stay between the ICB and EPI groups.
LIMITATIONS
The number of included studies was small, and the quality of evidence was low.
CONCLUSIONS
ICB may be as effective as EPI for pain relief after thoracotomy.
Topics: Humans; Analgesia, Epidural; Thoracotomy; Nerve Block; Randomized Controlled Trials as Topic; Pain, Postoperative; Morphine; Nausea; Vomiting; Analgesics, Opioid
PubMed: 37192224
DOI: No ID Found -
Indian Journal of Anaesthesia Apr 2023Ultrasound-guided transversalis fascia plane block (TFPB) has been used for providing postoperative analgesia after various lower abdominal surgeries like iliac crest...
Ultrasound-guided transversalis fascia plane block (TFPB) has been used for providing postoperative analgesia after various lower abdominal surgeries like iliac crest bone harvesting, inguinal hernia repair, caesarean section and appendicectomy. After registering the protocol in PROSPERO, various databases like PubMed/Medline, Ovid, CENTRAL and clinicaltrials.gov were searched for randomized controlled trials and observational, comparative studies till October 2022. The risk of bias (RoB-2) scale was used to assess the quality of evidence. The database searched identified 149 articles. Out of these, 8 studies were identified for qualitative analysis and 3 studies were TFPB was compared to control in patients undergoing caesarean section were selected for quantitative analysis. At 12 hours, pain scores were significantly less in TFPB group when compared to control on movement with no heterogeneity. At other times, the pain scores were comparable. 24-hr opioid consumption was significantly less in TFPB group when compared to control with significant heterogeneity. Time to rescue analgesia was significantly less in TFPB group when compared to control with significant heterogeneity. Number of patients requiring rescue analgesia were significantly less in TFPB group when compared to control with no heterogeneity. Postoperative nausea/vomiting (PONV) was significantly less in TFPB group when compared to control with minimal heterogeneity. In conclusion, TFPB is a safe block which provides opioid-sparing postoperative analgesia and a delayed time to rescue analgesia with no significant difference in pain scores and lesser PONV postoperatively when compared to control in patients undergoing caesarean section.
PubMed: 37303881
DOI: 10.4103/ija.ija_43_23 -
BMC Women's Health May 2020Previous studies have demonstrated that appropriate treatment for postoperative pain can lead to improvement in depressive symptoms, however the association between... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies have demonstrated that appropriate treatment for postoperative pain can lead to improvement in depressive symptoms, however the association between adequate intrapartum pain control and the development of postpartum depression is not clear. The purpose of the study was to examine the effects of labor epidural analgesia and postpartum depression.
METHODS
We performed a quantitative systematic review in compliance with the PRISMA statement. We conducted a search of PubMed, Embase, the Cochrane Database of Systematic Reviews and Google Scholar databases. The primary outcome was a positive screen of postpartum depression among women who received labor epidural analgesia up to 3 months into the postpartum period. Meta-analysis was performed using the random effect model.
RESULTS
Of the 148 studies available, 9 studies with 4442 patients were included in the analysis. The use of labor analgesia on positive depression screen compared to control revealed no significant effect, OR (95% CI) of 1.02 (0.62 to 1.66, P = 0.94).
CONCLUSION
Based on current literature, the use of epidural analgesia for pain relief during labor doesn't appear to affect the likelihood of postpartum depression. Future studies are warranted to further investigate these findings and identity other possible preventative interventions that reduce postpartum depression.
Topics: Analgesia, Epidural; Analgesics; Depression, Postpartum; Female; Humans; Labor Pain; Pain Management; Pregnancy
PubMed: 32393225
DOI: 10.1186/s12905-020-00948-0 -
Saudi Journal of Anaesthesia 2023Tizanidine is a centrally acting α2 agonist which has been used as a premedication due to its opioid-sparing and sympatholytic properties. This systematic review... (Review)
Review
Tizanidine is a centrally acting α2 agonist which has been used as a premedication due to its opioid-sparing and sympatholytic properties. This systematic review assessed the safety and feasibility of oral tizanidine. After registering the protocol with PROSPERO (CRD42022368546), randomized controlled trials and non-randomized observational studies were searched in various databases. The primary outcome was intraoperative opioid use; the secondary outcomes were 24-hr opioid consumption, pain scores, time to rescue analgesia, and adverse events. The risk of bias scale was used to assess the quality of evidence. Out of 202 studies identified, five studies fulfilled the inclusion criteria. Intraoperative opioid consumption was significantly less in the tizanidine group (MD: -2.40; 95% CI: -4.22, -0.59; = 0.010; I = 0 %). The 24-hr opioid consumption was comparable between both groups (MD: -42.53, 95% CI: -91.45, 6.39; = 0.09; I = 99%). Time to rescue analgesia was comparable between both groups (MD: 308.22; 95% CI: -263.67, 880.11, = 0.29, I = 100%). Pain scores at 6 and 12 hours were comparable (MD: -1.37; 95% CI: -3.68, 0.94; = 0.24; I = 97%) and (MD: -1.76; 95% CI: -4.06, 0.53; = 0.13; I = 95%); however, at 24 hours the scores were better in the tizanidine group (MD: -1.10; 95% CI: -1.50, -0.69; < 0.0001 I = 0%). Although dry mouth was significantly more in the tizanidine group (MD: 5.35; 95% CI: 1.72, 16.62; = 0.004; I = 0%), postoperative nausea/vomiting and dizziness were comparable. Tizanidine reduces intraoperative opioid consumption without significant adverse events. However, it does not provide effective opioid-sparing analgesia or reduced opioid requirement in the first 24 hours after surgery.
PubMed: 37260650
DOI: 10.4103/sja.sja_780_22 -
PloS One 2016Treatment effects of electroacupuncture for patients with subjective tinnitus has yet to be clarified. (Review)
Review
BACKGROUND
Treatment effects of electroacupuncture for patients with subjective tinnitus has yet to be clarified.
OBJECTIVES
To assess the effect of electroacupuncutre for alleviating the symptoms of subjective tinnitus.
METHODS
Extensive literature searches were carried out in three English and four Chinese databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang Chinese Digital Periodical and Conference Database, VIP, and ChiCTR).The date of the most recent search was 1 June 2014. Randomized controlled trials (RCTs) or quasi-RCTs were included. The titles, abstracts, and keywords of all records were reviewed by two authors independently. The data were collected and extracted by three authors. The risk of bias in the trials was assessed in accordance with the Cochrane Handbook, version 5.1.0. (http://www.handbook.cochrane.org). Eighty-nine studies were retrieved. After discarding 84 articles, five studies with 322 participants were identified. Assessment of the methodological quality of the studies identified weaknesses in all five studies. All studies were judged as having a high risk of selection and performance bias. The attrition bias was high in four studies. Incompleteness bias was low in all studies. Reporting bias was unclear in all studies. Because of the limited number of trials included and the various types of interventions and outcomes, we were unable to conduct pooled analyses.
CONCLUSIONS
Due to the poor methodological quality of the primary studies and the small sample sizes, no convincing evidence that electroacupuncture is beneficial for treating tinnitus could be found. There is an urgent need for more high-quality trials with large sample sizes for the investigation of electroacupuncture treatment for tinnitus.
Topics: Acupuncture Therapy; Electroacupuncture; Humans; Publication Bias; Randomized Controlled Trials as Topic; Tinnitus
PubMed: 26938213
DOI: 10.1371/journal.pone.0150600 -
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 -
Computational and Mathematical Methods... 2022In recent years, erector spinae plane block (ESPB) has been increasingly used as a new regional block technique for postoperative analgesia; however, little is known on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In recent years, erector spinae plane block (ESPB) has been increasingly used as a new regional block technique for postoperative analgesia; however, little is known on its benefits. Therefore, we performed a systematic review and meta-analysis to investigate the efficacy and safety of ESPB in lumbar spine surgery.
METHODS
Databases including PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs) comparing ESPB with no block in lumbar spine surgery until September 30, 2021. The primary outcome was opioid consumption after surgery. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the quality of included studies.
RESULTS
Fifteen RCTs involving 980 patients were included in the study. Opioid consumption 24 hours after surgery was significantly lower in the ESPB group standardized mean difference (SMD = -2.27, 95% confidence interval (95% CI) (-3.21, -1.32); < 0.01). ESPB reduced pain scores at rest and on movement within 48 hours after surgery and the incidence of the postoperative rescue analgesia (RR = 0.32, 95% CI (0.31, 0.80); = 0.02), while it significantly prolonged time to first rescue analgesia (SMD = 4.87, 95% CI (2.84, 6.90); < 0.01). Moreover, significantly better patient satisfaction was associated with ESPB (SMD = 1.89, 95% CI (1.03, 2.74); < 0.01).
CONCLUSION
EPSB provides effective and safe postoperative analgesia after lumbar spine surgery.
Topics: Analgesia; Analgesics, Opioid; Humans; Nerve Block; Pain, Postoperative; Randomized Controlled Trials as Topic
PubMed: 35991141
DOI: 10.1155/2022/3264142