Pudendal nerve block in hemorrhoid surgery: A systematic review and meta-analysis

Abstract Objective Postoperative pain represents an important issue in traditional hemorrhoidectomy. Optimal pain control is mandatory, in particular in a surgical day care setting. The aim of this study was to investigate the use of pudendal nerve block (PNB) in patients undergoing hemorrhoidectomy. Methods PubMed, Google Scholar, Cochrane Library and Web of Science databases were searched up to December 2020. Randomized trials evaluating the PNB use on postoperative outcomes in patients undergoing hemorrhoidectomy were selected. Opioid consumption, pain on the visual analogue scale, length of hospital stay and readmission rate were the main outcomes of interest and were plotted by using a random-effect model. Results The literature search revealed 749 articles, of which 14 with were deemed eligible. A total of 1,214 patients was included, of whom 565 received the PNB and 649 did not. After hemorrhoidectomy, patients in the PNB group received opioids less frequently (RR 0.364, 95%CI 0.292 to 0.454, p < 0.001) and in a lower cumulative dose (SMD -0.935, 95%CI -1.280 to -0.591, p < 0.001). Patients receiving PNB experienced less pain at 24 hours (SMD -1.862, 95%CI -2.495 to -1.228, p < 0.001), had a shorter length of hospital stay (SMD -0.742, 95%CI -1.145 to -0.338, p < 0.001) and a lower readmission rate (RR 0.239, 95%CI 0.062 to 0.916, p = 0.037). Sensitivity analysis excluded the occurrence of publication bias on the primary endpoint and the overall evidence quality was judged “high”. Conclusion This systematic review and meta-analysis shows significant advantages of the PNB use. A reduction in opioid consumption, postoperative pain, complications and length of stay can be demonstrated. Despite limitations, PNB in patients undergoing hemorrhoidectomy should be taken into account.

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Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis

Respiration ◽

10.1159/000510615 ◽

2021 ◽

Vol 100 (1) ◽

pp. 64-76

Author(s):

Yan Yu ◽

Wei Liu ◽

Hong-Li Jiang ◽

Bing Mao

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Stay ◽

Readmission Rate ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mortality And Morbidity ◽

Icu Stay ◽

Copd Patients ◽

The Impact

Background: Patients with chronic obstructive pulmonary disease (COPD) are at a heightened risk of pneumonia. Whether coexisting community-acquired pneumonia (CAP) can predict increased mortality in hospitalized COPD patients is still controversial. Objective: This systematic review and meta-analysis aims to assess the association between CAP and mortality and morbidity in COPD patients hospitalized for acute worsening of respiratory symptoms. Methods: In this review, cohort studies and case-control studies investigating the impact of CAP in hospitalized COPD patients were retrieved from 4 electronic databases from inception until December 2019. Methodological quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale. The primary outcome was mortality. The secondary outcomes included length of hospital stay, need for mechanical ventilation, intensive care unit (ICU) admission, length of ICU stay, and readmission rate. The Mantel-Haenszel method and inverse variance method were used to calculate pooled relative risk (RR) and mean difference (MD), respectively. Results: A total of 18 studies were included. The presence of CAP was associated with higher mortality (RR = 1.85; 95% CI: 1.50–2.30; p < 0.00001), longer length of hospital stay (MD = 1.89; 95% CI: 1.19–2.59; p < 0.00001), more need for mechanical ventilation (RR = 1.48; 95% CI: 1.32–1.67; p < 0.00001), and more ICU admissions (RR = 1.58; 95% CI: 1.24–2.03; p = 0.0002) in hospitalized COPD patients. CAP was not associated with longer ICU stay (MD = 5.2; 95% CI: −2.35 to 12.74; p = 0.18) or higher readmission rate (RR = 1.02; 95% CI: 0.96–1.09; p = 0.47). Conclusion: Coexisting CAP may be associated with increased mortality and morbidity in hospitalized COPD patients, so radiological confirmation of CAP should be required and more attention should be paid to these patients.

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Effects of perioperative intravenous lidocaine infusion for postoperative pain and recovery in elderly patients undergoing surgery: a systematic review and meta-analysis of randomized controlled trials

10.21203/rs.2.21895/v1 ◽

2020 ◽

Author(s):

Yihao Zhu ◽

Fei Wang ◽

Lei Yang ◽

Tao Zhu

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Elderly Patients ◽

Hospital Stay ◽

Postoperative Nausea ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Aged Patients ◽

Randomized Controlled

Abstract Background Improving postoperative pain and other potential benefits of IV lidocaine remains a significant debate in elderly patients. This meta-analysis aims to estimate the effect perioperative continuous IV lidocaine in elderly patients undergoing surgery. Method Pubmed/Medline, Web of Science, Embase and CENTRAL through OVID SP were independently searched until November 1, 2019 by two authors. This systematic review and meta-analysis included all randomized controlled trials that compared the effect of continuous IV lidocaine and any placebo or no treatment in aged patients after surgery. Primary outcomes were length of hospital stay and postoperative pain score and second outcomes were postoperative nausea and vomiting, opioid consumption, gastrointestinal recovery and postoperative neuropsychological function status scale. Result Eighteen studies(1175 patients) were included. Meta-analysis suggested that IV lidocaine reduce the postoperative pain scores(visual analogue scale, 0-10cm) at 2h(SMD:-1.30, 95% CI -1.90 to -0.70), 4h(SMD:-1.20, 95% CI -1.91 to -0.49), 6h(SMD:-0.87, 95%CI -1.72 to 0.02), 8h(SMD:-0.84, 95%CI -1.40 to -0.27), 12h(SMD:-0.73, 95%CI -1.14 to -0.32), 24h(SMD:-0.39, 95%CI -0.66 to -0.11), shorten length of hospital stay(MD: -0.30, 95%CI -0.50 to -0.09), decrease the requirement of opioid drugs(SMD: -0.31, 95%CI -0.31 to -0.01) and the incidence of postoperative nausea(OR: 0.52, 95%CI 0.31 to 0.87) in elderly patients undergoing surgery. Conclusion The evidence suggested that IV lidocaine significantly reduce postoperative pain intensity and opioid consumption and shorten the length of hospital stay in aged patients. In addition, it was shown that IV lidocaine decrease the requirement of postoperative opioid and incidence of postoperative nausea compared to control group. IV lidocaine maybe a useful assistant during general anesthesia owing to its beneficial effect in several outcomes in geratic patients undergoing surgery.

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Pudendal Nerve Block in Hemorrhoid Surgery: A Systematic Review and Meta-analysis

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000001985 ◽

2021 ◽

Vol 64 (5) ◽

pp. 617-631

Author(s):

Francesco Mongelli ◽

Giorgio Treglia ◽

Davide La Regina ◽

Matteo Di Giuseppe ◽

Jacopo Galafassi ◽

...

Keyword(s):

Systematic Review ◽

Nerve Block ◽

Pudendal Nerve ◽

Meta Analysis ◽

Pudendal Nerve Block

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Laparoscopic cholecystectomy versus minilaparotomy in cholelithiasis: systematic review and meta-analysis

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000200013 ◽

2014 ◽

Vol 27 (2) ◽

pp. 148-153 ◽

Cited By ~ 9

Author(s):

Paula Marcela Vilela CASTRO ◽

Denise AKERMAN ◽

Carolina Brito MUNHOZ ◽

Iara do SACRAMENTO ◽

Mônica MAZZURANA ◽

...

Keyword(s):

Systematic Review ◽

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

Return To Work ◽

Hospital Stay ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Work Activities

INTRODUCTION: A introdução da técnica laparoscópica em 1985 foi um fator importante na colecistectomia por representar técnica menos invasiva, resultado estético melhor e menor risco cirúrgico comparado ao procedimento laparotômico. AIM: To compare laparoscopic and minilaparotomy cholecystectomy in the treatment of cholelithiasis. METHODS: A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) was performed. The keywords used were "Cholecystectomy", "Cholecystectomy, Laparoscopic" and "Laparotomy". The methodological quality of primary studies was assessed by the Grade system. RESULTS: Ten randomized controlled trials were included, totaling 2043 patients, 1020 in Laparoscopy group and 1023 in Minilaparotomy group. Laparoscopic cholecystectomy dispensed shorter length of hospital stay (p<0.00001) and return to work activities (p<0.00001) compared to minilaparotomy, and the minilaparotomy shorter operative time (p<0.00001) compared to laparoscopy. Laparoscopy decrease the risk of postoperative pain (NNT=7) and infectious complications (NNT=50). There was no statistical difference between the two groups regarding conversion (p=0,06) and surgical reinterventions (p=0,27), gall bladder's perforation (p=0,98), incidence of common bile duct injury (p=1.00), surgical site infection (p=0,52) and paralytic ileus (p=0,22). CONCLUSION: In cholelithiasis, laparoscopic cholecystectomy is associated with a lower incidence of postoperative pain and infectious complications, as well as shorter length of hospital stay and time to return to work activities compared to minilaparotomy cholecystectomy.

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The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

10.21203/rs.2.15256/v1 ◽

2019 ◽

Author(s):

Munazzah Rafique ◽

Jacqueline Y Thompson ◽

Dania Al-Jaroudi ◽

Ahmed Al-Badr

Keyword(s):

Systematic Review ◽

Pelvic Floor ◽

Randomized Controlled Trials ◽

Nerve Block ◽

Pudendal Nerve ◽

Meta Analysis ◽

Controlled Trials ◽

Pudendal Nerve Block ◽

Randomized Controlled ◽

Significant Difference

Abstract Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly used in clinical practice during pelvic floor and vaginal surgeries. However, its effectiveness is unclear. To update the evidence base we summarised short- and intermediate-term outcomes of pre-emptive analgesia using pudendal nerve block with bupivacaine as an approach in the management of pelvic floor and vaginal surgeries. Methods: We searched the CENTRAL, PubMed, ClinicalTrials.gov, google scholar and Open Grey from inception until April 2019. The citation lists of relevant papers were also searched. Randomized controlled trials (RCTs) of women who underwent perineal, pelvic floor or vaginal surgeries and received pre-emptive analgesia using a pudendal nerve block were included. Two authors independently screened and selected eligible trials as well as performed data extraction and quality assessment. Disagreements were resolved via consensus and an adjudicator was involved when consensus was not achieved. Data was narratively synthesized, when possible, data was pooled in RevMan 5 using random effects model. Results: Four RCTs with a total of 349 participants were eligible for inclusion. We found evidence of small effect for improvement in post-operative pain scores; requirements for opioids, SMD: -0.89 (95% CI: -1.19, -0.59) and non-steroidal anti-inflammatories SMD -1.04 (95% CI: -1.64, -0.43) in favour of the PNB versus control group. The risk ratio for adverse effects 0.42 (95% CI: 0.18, 0.99) favoured PNB. There was no significant difference between groups for length of hospital stay, MD: -0.82 (95% CI: -5.34, 3.69) and return to normal activity. Conclusion:We found inconclusive evidence that pre-emptive pudendal block using bupivacaine may improve postoperative pain and recovery in perineal, pelvic floor or vaginal surgeries. However, due to the scant and poor quality of evidence included in this systematic review, well-designed and adequately powered RCTs that adhere to reporting guidelines and evaluate key outcomes are needed to inform clinical guidelines on the use of pre-emptive pudendal block. Key words:pre-emptive analgesia, bupivacaine, pudendal nerve block, vaginal surgery, pelvic organ prolapse, systematic review, meta-analysis

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Haemostatic devices in parotid surgery: a systematic review

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001973 ◽

2021 ◽

pp. 1-7

Author(s):

L Allen ◽

C MacKay ◽

M H Rigby ◽

J Trites ◽

S M Taylor

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Facial Nerve ◽

Hospital Stay ◽

Outcome Measures ◽

Meta Analysis ◽

Operating Time ◽

Length Of Hospital Stay ◽

Operative Blood Loss ◽

Parotid Surgery

Abstract Objective The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. Method A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. Results A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. Conclusion Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

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Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00228 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0022

Author(s):

Arianna L. Gianakos ◽

Filippo Romanelli ◽

Malaka Badri ◽

Naina Rao ◽

Bart Lubberts ◽

...

Keyword(s):

Systematic Review ◽

Pain Management ◽

Postoperative Pain ◽

Continuous Infusion ◽

Nerve Block ◽

Opioid Consumption ◽

Foot And Ankle ◽

Complication Risk ◽

Prospective Comparison ◽

Ankle Surgery

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery. Methods: A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years. Results: Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications. Conclusion: Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]

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Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Pediatric Surgery International ◽

10.1007/s00383-019-04610-1 ◽

2019 ◽

Vol 36 (3) ◽

pp. 261-269 ◽

Cited By ~ 3

Author(s):

Sonia Maita ◽

Björn Andersson ◽

Jan F. Svensson ◽

Tomas Wester

Keyword(s):

Systematic Review ◽

Acute Appendicitis ◽

Hospital Stay ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Nonoperative Treatment ◽

Controlled Study ◽

Randomized Controlled ◽

Search Terms ◽

Initial Hospital

AbstractAcute appendicitis is the most common surgical emergency in children. Nonoperative treatment of nonperforated acute appendicitis in children is an alternative to appendectomy. The purpose of this systematic review and meta-analysis was to determine the outcomes of nonoperative treatment of nonperforated acute appendicitis in children in the literature. Databases were searched to identify abstracts, using predefined search terms. The abstracts were reviewed by two independent reviewers and articles were selected according to inclusion and exclusion criteria. Data were extracted by the two reviewers and analyzed. The literature search yielded 2743 abstracts. Twenty-one articles were selected for analysis. The study design was heterogenous, with only one randomized controlled study. The symptoms resolved in 92% [95% CI (88; 96)] of the nonoperatively treated patients. Meta-analysis showed that an additional 16% (95% CI 10; 22) of patients underwent appendectomy after discharge from initial hospital stay. Complications and length of hospital stay was not different among patients treated with antibiotics compared with those who underwent appendectomy. Nonoperative treatment of nonperforated acute appendicitis children is safe and efficient. There is a lack of large randomized controlled trials to compare outcomes of nonoperative treatment with appendectomy.

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Is Endoscopic Discectomy the Next Gold Standard in the Management of Lumbar Disc Disease? Systematic Review and Superiority Analysis

Global Spine Journal ◽

10.1177/2192568220948814 ◽

2020 ◽

pp. 219256822094881

Author(s):

Sathish Muthu ◽

Eswar Ramakrishnan ◽

Girinivasan Chellamuthu

Keyword(s):

Systematic Review ◽

Hospital Stay ◽

Gold Standard ◽

Lumbar Disc ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Disc Disease ◽

Lumbar Disc Disease ◽

Endoscopic Discectomy ◽

Duration Of Surgery

Study Design: Systematic review and meta-analysis. Objectives: We performed this meta-analysis to evaluate whether endoscopic discectomy (ED) shows superiority compared with the current gold standard of microdiscectomy (MD) in management of lumbar disc disease. Materials and Methods: We conducted independent and duplicate electronic database search including PubMed, Embase, and Cochrane Library from 1990 till April 2020 for studies comparing ED and MD in the management of lumbar disc disease. Analysis was performed in R platform using OpenMeta[Analyst] software. Results: We included 27 studies, including 11 randomized controlled trials (RCTs), 7 nonrandomized prospective, and 9 retrospective studies involving 4018 patients in the meta-analysis. We stratified the results based on the study design. Considering the heterogeneity in some results between study designs, we weighed our conclusion essentially based on results of RCTs. On analyzing the RCTs, superiority was established at 95% confidence interval for ED compared with MD in terms of functional outcomes like Oswestry Disability Index (ODI) score ( P = .008), duration of surgery ( P = .023), and length of hospital stay ( P < .001) although significant heterogeneity was noted. Similarly, noninferiority to MD was established by ED in other outcomes like visual analogue scale score for back pain ( P = .860) and leg pain ( P = .495), MacNab classification ( P = .097), recurrences ( P = .993), reoperations ( P = .740), and return-to-work period ( P = .748). Conclusion: Our meta-analysis established the superiority of endoscopic discectomy in outcome measures like ODI score, duration of surgery, overall complications, length of hospital stay and noninferiority in other measures analyzed. With recent advances in the field of ED, the procedure has the potential to take over the place of MD as the gold standard of care in management of lumbar disc disease.

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Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-045031 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045031

Author(s):

Zongqing Lu ◽

Xingxing Zhu ◽

Tianfeng Hua ◽

Jin Zhang ◽

Wenyan Xiao ◽

...

Keyword(s):

Systematic Review ◽

Acute Pancreatitis ◽

Cohort Studies ◽

Hospital Stay ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Infectious Complications ◽

Efficacy And Safety ◽

All Cause Mortality ◽

Abdominal Paracentesis

ObjectivesTo conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional ‘step-up’ strategy based on percutaneous catheter drainage (PCD).DesignSystematic review and meta-analysis.MethodsPubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional ‘step-up’ strategy based on PCD were included.OutcomesThe primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay.ResultsFive cohort studies and three RCTs were included in the analysis. Compared with the conventional ‘step-up’ method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) −0.31, 95% CI −0.53 to –0.10 and p=0.005; RCTs: SMD −0.45, 95% CI −0.64 to –0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD −2.49, 95% CI −4.46 to –0.51 and p<0.001; RCTs: SMD −0.67, 95% CI −0.89 to –0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04).ConclusionsThe findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the ‘step-up’ strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials.PROSPERO registration numberCRD42020168537.

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