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The Cochrane Database of Systematic... Dec 2012Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local... (Review)
Review
BACKGROUND
Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local anaesthetic and surgery. We aimed to examine the evidence for the relative efficacy of these interventions. This review was first published in 2008. Searches were updated in 2010 and 2012.
OBJECTIVES
To assess the relative efficacy of commonly used treatments for meralgia paraesthetica.
SEARCH METHODS
We searched the Cochrane Neuromuscular Disease Group Specialized Register (1 October 2012), CENTRAL (2012, issue 9 in The Cochrane Library), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012) and CINAHL Plus (January 1937 to October 2012) for randomised controlled studies. Non-randomised studies were identified by searching MEDLINE (January 1966 to October 2012) and EMBASE (January 1980 to October 2012). We also inspected the reference lists of these studies.
SELECTION CRITERIA
We were unable to identify any randomised controlled trials (RCTs) or quasi-RCTs. We therefore looked for high quality observational studies meeting the following criteria: (1) At least five cases of meralgia paraesthetica. (2) Follow-up of at least three months after intervention (if any). (3) At least 80% of cases followed up.
DATA COLLECTION AND ANALYSIS
Three authors independently extracted relevant data from each study meeting the selection criteria and transferred into a data extraction form.
MAIN RESULTS
We found no RCTs or quasi-RCTs in the original review or updates in 20011 and 2012. Cure or improvement have been described in high quality observational studies: (1) A single study describes spontaneous improvement of meralgia paraesthetica in 20 (69%) of 29 cases. (2) Four studies evaluating the injection of corticosteroid and local anaesthetic found cure or improvement in 130 (83%) out of a combined total of 157 cases. (3) Surgical treatments have been found to be beneficial in 264 (88%) out of 300 cases treated with decompression (nine studies); and 45 (94%) out of 48 cases treated with neurectomy (three studies). (4) Ninety-nine (97%) out of 102 patients with iatrogenic meralgia paraesthetica recovered completely (three studies).
AUTHORS' CONCLUSIONS
In the absence of any published RCTs or quasi-RCTs, the objective evidence base for treatment choices in meralgia paraesthetica is weak. High quality observational studies report comparable high improvement rates for meralgia paraesthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy). However, a similar outcome has been reported without any intervention in a single natural history study.
Topics: Adrenal Cortex Hormones; Anesthetics, Local; Decompression, Surgical; Femoral Nerve; Femoral Neuropathy; Humans; Nerve Block; Nerve Compression Syndromes; Paresthesia; Thigh
PubMed: 23235604
DOI: 10.1002/14651858.CD004159.pub3 -
BMC Anesthesiology Nov 2015Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has... (Review)
Review
BACKGROUND
Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains controversial.
METHODS
Medline, Embase, and Cochrane Central Register of Controlled Trials were searched for studies assessing the effects of analgesic and anesthetic interventions on pain after radical prostatectomy. All searches were conducted in October 2012 and updated in June 2015.
RESULTS
Most treatments studied improved pain relief and/or reduced opioid requirements. However, there were significant differences in the study designs and the variables evaluated, precluding quantitative analysis and consensus recommendations.
CONCLUSIONS
This systematic review reveals that there is a lack of evidence to develop an optimal pain management protocol in patients undergoing radical prostatectomy. Most studies assessed unimodal analgesic approaches rather than a multimodal technique. There is a need for more procedure-specific studies comparing pain and analgesic requirements for open and minimally invasive surgical procedures. Finally, while we wait for appropriate procedure specific evidence from publication of adequate studies assessing optimal pain management after radical prostatectomy, we propose a basic analgesic guideline.
Topics: Analgesics; Analgesics, Opioid; Anesthetics; Humans; Male; Minimally Invasive Surgical Procedures; Pain, Postoperative; Practice Guidelines as Topic; Prostatectomy; Prostatic Neoplasms
PubMed: 26530113
DOI: 10.1186/s12871-015-0137-2 -
Brain and Behavior Aug 2023Elderly patients are prone to postoperative cognitive dysfunction (POCD). The comparison of the effects of anesthetic adjuvant drugs on POCD in elderly patients... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Elderly patients are prone to postoperative cognitive dysfunction (POCD). The comparison of the effects of anesthetic adjuvant drugs on POCD in elderly patients undergoing noncardiac surgery remains controversial.
METHODS
The final search took place on June 10, 2023. Randomized controlled trials including ketamine, ulinastatin, dexmedetomidine, parecoxib, and midazolam on the prevention and treatment of POCD in elderly undergoing noncardiac surgery were collected. A Bayesian network meta-analysis was performed to quantitatively combine the evidence.
RESULTS
A total of 35 randomized trials were finally included in this systematic review, and the overall risk of bias is Allocation concealment. These anesthetic adjuvant drugs did not show significant differences in preventing POCD on postoperative days 1 and 7 compared with each other, but ulinastatin may be more effective in preventing POCD than dexmedetomidine [odds ratio (OR) = 0.28, 95% confidence interval (CI) = (0.10, 0.71)] and parecoxib [OR = 0.3, 95% CI = (0.10, 0.82 on postoperative day 3. The efficiency ranking results also find that ulinastatin and ketamine might provide better effects regarding POCD prevention.
CONCLUSIONS
Ketamine and ulinastatin might have better effects in preventing POCD in elderly patients undergoing noncardiac surgery. Our meta-analysis provided evidence for the use of ulinastatin and ketamine in the prevention of POCD in elderly patients undergoing noncardiac surgery.
Topics: Humans; Aged; Postoperative Cognitive Complications; Postoperative Complications; Ketamine; Dexmedetomidine; Adjuvants, Anesthesia; Bayes Theorem; Network Meta-Analysis; Anesthetics; Cognitive Dysfunction
PubMed: 37431799
DOI: 10.1002/brb3.3149 -
The Cochrane Database of Systematic... Mar 2015Surgery on fingers is a common procedure in emergency and day care surgery. Adrenaline combined with lidocaine can prolong digital nerve block and provide a bloodless... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgery on fingers is a common procedure in emergency and day care surgery. Adrenaline combined with lidocaine can prolong digital nerve block and provide a bloodless operating field. Extended postoperative pain relief can reduce the need for analgesics and can facilitate hand rehabilitation. Conventionally, adrenaline is avoided at anatomical sites with end arteries such as digits, penis and pinna because of concerns about arterial spasm, ischaemia and gangrene distal to the site of drug infiltration.
OBJECTIVES
To assess the safety and efficacy of use of adrenaline (any dilution) combined with lidocaine (any dilution) for digital nerve blocks (fingers and toes).
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 11, 2014), MEDLINE via Ovid SP (1966 to 18 November 2014) and EMBASE via Ovid SP (1980 to 18 November 2014). We also searched specific websites, such as www.indmed.nic.in; www.cochrane-sadcct.org; and www.Clinicaltrials.gov.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) that compared the use of adrenaline with lidocaine and plain lidocaine in patients undergoing surgery on digits (fingers and toes). Our primary outcomes were duration of anaesthesia, adverse outcomes such as ischaemia distal to the injection site and cost analysis. Our secondary outcomes were duration of postoperative pain relief and reduced bleeding during surgery.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration. Two review authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. We performed all analyses on an intention-to-treat basis. We used a fixed-effect model when no evidence of significant heterogeneity between studies was found and a random-effects model when heterogeneity was likely.
MAIN RESULTS
We included four RCTs with 167 participants. Risk of bias of the included studies was high, as none of them reported method of randomization, allocation concealment or blinding. Only one trial mentioned our primary outcome of duration of anaesthesia. The mean difference in duration of anaesthesia with use of adrenaline with lidocaine was 3.20 hours (95% confidence interval (CI) 2.48 to 3.92 hours; one RCT, 20 participants; low-quality evidence). No trial reported adverse events such as ischaemia distal to the injection site, and no trial reported cost analysis. One trial mentioned the secondary outcome of duration of postoperative pain relief, but available data were insufficient for analysis of the findings. Two trials reported the secondary outcome of reduced bleeding during surgery.Bleeding during surgery was observed in nine out of 52 participants as compared with 25 out of 51 participants in the adrenaline with lidocaine and plain lidocaine groups, respectively. The risk ratio for bleeding in the adrenaline with lidocaine group was 0.35 (95% CI 0.19 to 0.65; two RCTs, 103 participants; low-quality evidence).
AUTHORS' CONCLUSIONS
From the limited data available, evidence is insufficient to recommend use or avoidance of adrenaline in digital nerve blocks. The evidence provided in this review indicates that addition of adrenaline to lidocaine may prolong the duration of anaesthesia and reduce the risk of bleeding during surgery, although the quality of the evidence is low. We have identified the need for researchers to conduct large trials that focus on other important outcomes such as adverse events, cost analysis and duration of postoperative pain relief.
Topics: Adolescent; Adult; Anesthetics, Local; Child; Child, Preschool; Emergencies; Epinephrine; Female; Finger Injuries; Fingers; Humans; Infant; Lidocaine; Male; Nerve Block; Randomized Controlled Trials as Topic; Toes
PubMed: 25790261
DOI: 10.1002/14651858.CD010645.pub2 -
Pain Physician Jul 2020Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered... (Comparative Study)
Comparative Study Meta-Analysis
Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis.
BACKGROUND
Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin.
OBJECTIVES
To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage.
RESULTS
Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], -0.006; 95% confidence interval (CI), -0.275 to 0.263; P = 0.963; I² = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, -1.231 to 1.549; P = 0.823; I² = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, -0.093; 95% CI, -5.952 to 5.766; P = 0.975; I² = 0.0% at 12 months).
LIMITATIONS
Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies.
CONCLUSIONS
The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain.
KEY WORDS
Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial.
Topics: Anesthetics, Local; Chronic Pain; Drug Therapy, Combination; Humans; Injections, Epidural; Neck Pain; Pain Management; Radiculopathy; Steroids; Treatment Outcome
PubMed: 32709169
DOI: No ID Found -
Frontiers in Pain Research (Lausanne,... 2022Pain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression... (Review)
Review
Pain and depression frequently co-occur. Due to its antidepressant and analgesic properties, ketamine has been used for the management of treatment-resistant depression and pain. This systematic review examined the literature on the efficacy of sub-anesthetic doses of ketamine in individuals experiencing comorbid depression and chronic pain (CDCP), as well as comorbid depression and acute pain (CDAP). A secondary objective was to provide an assessment of dosage, route, and adverse effects of ketamine treatment for CDCP and CDAP. A literature search was conducted on MEDLINE, PsycINFO, and Embase databases, coupled with a manual screening of the bibliography sections of included articles. In addition, registered ongoing and planned trials were searched on Clinicaltrials.gov. The end date of the search was April 9th, 2022. Included studies assessed changes in depression and pain in patients receiving at least one sub-anesthetic dose of ketamine. Assessment of quality was conducted using the GRADE checklist. Of the 7 CDCP clinical trials, 3 reported a reduction in depression and pain, 3 reported a reduction in depression or pain only, and 1 reported no improvement in either comorbidity. Among the 7 CDAP clinical trials, 4 studies found improvements in depression and pain while the remaining 3 reported improvements in only one parameter. Ten of the 12 case studies and 2 of the 3 observational studies assessing CDCP and CDAP found improvements in pain and depression scores post-treatment with effects of variable duration. The planned methodologies of the registered clinical trials are in line with those of the published research. Preliminary evidence supports the efficacy of ketamine in treating CDCP and CDAP. However, the current review identified a small number of heterogeneous studies with mixed results, preventing comprehensive conclusions. More longitudinal placebo-controlled studies are needed to identify the effects of ketamine for patients with CDCP and CDAP.
PubMed: 36353699
DOI: 10.3389/fpain.2022.1022767 -
Asian Journal of Surgery Dec 2023
Meta-Analysis
Topics: Humans; Lidocaine; Cholecystectomy, Laparoscopic; Anesthetics, Local; Pain Management; Analgesia; Pain; Pain, Postoperative; Analgesics, Opioid
PubMed: 37597985
DOI: 10.1016/j.asjsur.2023.07.132 -
Journal of Cardiothoracic and Vascular... Feb 2022No systematic studies on retractions in cardiothoracic and vascular anesthesia exist. The aim of this analysis was to identify characteristics and trends of retractions...
OBJECTIVES
No systematic studies on retractions in cardiothoracic and vascular anesthesia exist. The aim of this analysis was to identify characteristics and trends of retractions in this field over the past three decades.
DESIGN
A search of the Retraction Watch Database for retracted articles published between 1990 and 2020 in the field of cardiothoracic and vascular anesthesia was performed.
SETTING
A bibliometric study.
PARTICIPANTS
Five thousand three hundred forty-four retractions with the term "medicine" in the subject code were selected. Retractions of full-length English articles reporting findings in cardiothoracic and vascular anesthesia were included.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
A total of 63 articles published in 31 journals from January 1990 to August 2020 were retracted. The majority were original articles (n = 60, 95.2%) and retracted for scientific misconduct (n = 50, 79.4%). The percentage of retractions due to misconduct increased from 2010, with a spike in 2011 (n = 26/50, 52.0%), and reached a plateau in 2014. The three most common reasons for retraction were misconduct by the author (n = 31, 49.2%), duplication (n = 12, 19.0%), and errors within the manuscript (n = 11, 17.5%). The median time from publication to retraction was 4.3 years (IQR: 1.7-9.4) and decreased significantly over time (p < 0.001). The median impact factor (IF) of the journals that published retracted articles was 3.5 (IQR 2.0-4.5) and decreased significantly over the study period (p < 0.001).
CONCLUSION
Scientific misconduct represents the most common reason for retraction in cardiothoracic and vascular anesthesia. The median time to retraction and journal IF decreased significantly over time. While this is promising, future efforts should be made to screen for falsified data and standardize the processes after retraction to highlight problematic manuscripts.
Topics: Anesthesia; Anesthesiology; Bibliometrics; Biomedical Research; Databases, Factual; Humans; Scientific Misconduct
PubMed: 34600831
DOI: 10.1053/j.jvca.2021.09.005 -
Minerva Anestesiologica 2023This review and meta-analysis of randomized controlled trials (RCTs) assessed the side effects and efficacy of esketamine combined with propofol in procedural sedation... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
This review and meta-analysis of randomized controlled trials (RCTs) assessed the side effects and efficacy of esketamine combined with propofol in procedural sedation and analgesia.
EVIDENCE ACQUISITION
The PubMed, MEDLINE, Embase and Cochrane Library databases were searched for relevant studies occurring between their inceptions and September 2022. The primary outcome was the incidence of sedation-related adverse events. Secondary outcomes included recovery time, total consumption of propofol and body movement.
EVIDENCE SYNTHESIS
Data from a total of seven RCTs enrolling 808 patients were included in the meta-analysis. Pooling of data showed that compared with other drug regimens, the esketamine and propofol combination was associated with a reduction in the risk of hypotension (relative risk [RR]: 0.37, 95% confidence interval [CI]: 0.25 to 0.56) and bradycardia (RR: 0.34, 95% CI: 0.15 to 0.80) as well as an increase in the risk of agitation (RR: 6.29, 95% CI: 1.15 to 34.32). The results also indicated a decrease in propofol consumption (standardized mean difference: -1.45, 95% CI: -2.39 to -0.50) with the use of the esketamine and propofol combination. No significant difference was observed between the two groups in respiratory depression, nausea/vomiting, recovery time or body movement.
CONCLUSIONS
Esketamine combined with propofol has an advantage in reducing the incidence of hypotension and bradycardia during procedural sedation and analgesia, but it may increase the risk of agitation in the recovery phase. More studies of high quality are needed before the widespread adoption of the combination of esketamine and propofol.
Topics: Humans; Propofol; Bradycardia; Pain; Analgesia; Hypotension
PubMed: 36988407
DOI: 10.23736/S0375-9393.23.17100-8 -
Pain Physician 2012The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The contribution of the sacroiliac joint to low back and lower extremity pain has been a subject of debate with extensive research. It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints. In spite of this, there are currently no definite conservative, interventional, or surgical management options for managing sacroiliac joint pain. In addition, there continue to be significant variations in the application of various techniques as well as a paucity of literature.
STUDY DESIGN
A systematic review of therapeutic sacroiliac joint interventions.
OBJECTIVE
To evaluate the accuracy of therapeutic sacroiliac joint interventions.
METHODS
The available literature on therapeutic sacroiliac joint interventions in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria for randomized trials of interventional techniques and the criteria developed by the Newcastle-Ottawa Scale for observational studies. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature published from 1966 through December 2011 that was identified through searches of PubMed and EMBASE, and manual searches of the bibliographies of known primary and review articles.
OUTCOME MEASURES
The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake.
RESULTS
For this systematic review, 56 studies were considered for inclusion. Of these, 45 studies were excluded and a total of 11 studies met inclusion criteria for methodological quality assessment with 6 randomized trials and 5 non-randomized studies. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair.The evidence for effectiveness of intraarticular steroid injections is poor.The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor. The evidence for effectiveness of conventional radiofrequency neurotomy is poor.The evidence for pulsed radiofrequency is poor.
LIMITATIONS
The limitations of this systematic review include a paucity of literature on therapeutic interventions, variations in technique, and variable diagnostic standards for sacroiliac joint pain.
CONCLUSIONS
The evidence was fair in favor of cooled radiofrequency neurotomy and poor for short-term and long-term relief from intraarticular steroid injections, periarticular injections with steroids or botulin toxin, pulsed radiofrequency, and conventional radiofrequency neurotomy.
Topics: Anesthetics, Local; Humans; Low Back Pain; Pain Measurement; Sacroiliac Joint; Steroids; Treatment Outcome
PubMed: 22622913
DOI: No ID Found