scholarly journals The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901990027 ◽  
Author(s):  
Jian-Zuo Lu ◽  
Jia-Xing Fu ◽  
Da-feng Wang ◽  
Zhong-Liang Su ◽  
Yuan-Bo Zheng
Keyword(s):  
Pain Control ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Knee Surgery ◽  
Cochrane Library ◽  
Arthroscopic Knee Surgery ◽  
Substantial Impact ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Arthroscopic Knee

Introduction: The efficacy of intra-articular fentanyl supplementation for pain control after knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-articular fentanyl supplementation for pain intensity after arthroscopic knee surgery. Methods: We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through May 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of intra-articular fentanyl supplementation for arthroscopic knee surgery. This meta-analysis is performed using the random-effects model. Results: Four RCTs are included in the meta-analysis. Overall, compared with control group after knee arthroscopy, intra-articular fentanyl supplementation is associated with reduced pain scores at 1 h (standard mean difference (Std MD) = −3.50; 95% confidence interval (CI) = −5.68 to −1.32; p = 0.002), 2 h (Std MD = −4.73; 95% CI = −8.75 to −0.71; p = 0.02), and 8 h (Std MD = −5.02; 95% CI = −9.73 to −0.30; p = 0.04) but shows no substantial impact on pain scores at 4 h (Std MD = −3.94; 95% CI = −7.93 to 0.05; p = 0.05) or the supplementary analgesia (risk ratio = 0.56; 95% CI = 0.09–3.59; p = 0.54). Conclusions: Intra-articular fentanyl supplementation does benefit in pain control after knee arthroscopy.

scholarly journals The efficacy of spinal anaesthesia with fentanyl supplementation for arthroscopic knee surgery: A meta-analysis of randomized controlled studies

2020 ◽  
Vol 28 (2) ◽  
pp. 230949901989036
Author(s):  
Jianfeng Chen ◽  
Chao Yan ◽  
Chaosong Luo ◽  
Guizhen Li ◽  
Zong Yang
Keyword(s):  
Spinal Anaesthesia ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Onset Time ◽  
Knee Surgery ◽  
Cochrane Library ◽  
Control Group ◽  
Arthroscopic Knee Surgery ◽  
Randomized Controlled ◽  
Arthroscopic Knee

Introduction: The efficacy of spinal anaesthesia with fentanyl supplementation for arthroscopic knee surgery remains controversial. We conducted a systematic review and meta-analysis to explore the influence of fentanyl supplementation for arthroscopic knee surgery. Methods: We searched PubMed, Embase, Web of Science, EBSCO and Cochrane Library databases through May 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of fentanyl supplementation for arthroscopic knee surgery. This meta-analysis is performed using the random-effects model. Results: Five RCTs are included in the meta-analysis. Overall, compared with the control group for knee arthroscopy, fentanyl supplementation is associated with decreased time for sensory block regression to S1 (mean difference (MD) = −47.38; 95% confidence interval (CI) = −56.74 to −38.02; p < 0.00001), first ambulation (MD = −41.65; 95% CI = −65.11 to −18.19; p = 0.0005), first urination (MD = −23.45; 95% CI = −32.16 to −14.74; p < 0.00001) and hospital discharge (MD = −29.39; 95% CI = −44.73 to −14.06; p = 0.0002) but has no substantial influence on onset time of anaesthesia (MD = 0.50; 95% CI = −1.71 to 2.70; p = 0.66), duration for motor blockade (MD = −42.56; 95% CI = −119.18 to 34.07; p = 0.28), pruritus (risk ratio (RR) = 2.17; 95% CI = 0.28 to 16.90; p = 0.46) or nausea (RR = 0.42; 95% CI = 0.10 to 1.81; p = 0.25). Conclusions: Fentanyl supplementation benefits postoperative recovery after knee arthroscopy.

scholarly journals Ketamine Supplementation To Bupivacaine For Knee Arthroscopy: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Chunhong Li ◽  
Zhibo Xiao ◽  
Liuli Chen ◽  
Songli Pan
Keyword(s):  
Randomized Controlled Trials ◽  
Pain Control ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pain Scores

Abstract Introduction: The efficacy of ketamine supplementation to bupivacaine for pain management of knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine supplementation to bupivacaine on the postoperative pain intensity of knee arthroscopy.Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through July 2021 for randomized controlled trials (RCTs) assessing the effect of ketamine supplementation to bupivacaine on pain control of knee arthroscopy. This meta-analysis is performed using the random-effect model.Results: Four RCTs are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, ketamine supplementation remarkably decreases pain scores at 30 min (SMD=-0.98; 95% CI=-1.42 to -0.55; P<0.00001) and number of additional analgesics (OR=0.27; 95% CI=0.10 to 0.71; P=0.008), but reveals no significant impact on pain scores at 1 h (SMD=-1.34; 95% CI=-3.42 to 0.73; P=0.20), pain scores at 6 h (SMD=-0.33; 95% CI=-1.39 to 0.72; P=0.53), time of first analgesic requirement (SMD=1.27; 95% CI=-0.95 to 3.49; P=0.26) or additional analgesic consumption (SMD=-2.25; 95% CI=-5.89 to 1.40; P=0.23). Conclusions: Ketamine supplementation may improve the pain control when in combination with bupivacaine for knee arthroscopy.

scholarly journals Intra-articular magnesium to alleviate postoperative pain after arthroscopic knee surgery: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lijun Shi ◽  
Haiyun Zhu ◽  
Jinhui Ma ◽  
Li-Li Shi ◽  
Fuqiang Gao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Pain Intensity ◽  
Opioid Consumption ◽  
Knee Surgery ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Arthroscopic Knee Surgery ◽  
Randomized Controlled ◽  
Arthroscopic Knee

Abstract Objective We aimed to evaluate the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 h after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results In total, 11 studies involving 677 participants met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions Intra-articular magnesium is an effective and safe coadjuvant treatment for relieving postoperative pain intensity after arthroscopic knee surgery. Protocol registration at PROSPERO: CRD42020156403.

scholarly journals Analgesic Comparison of Perineural With Intravenous Dexamethasone on Interscalene Block for Shoulder Arthroscopy: a Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Liangku Huang ◽  
Peng Li ◽  
Liang Zhang ◽  
Guangming Kang ◽  
Haizhen Zhou ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Pain Control ◽  
Shoulder Arthroscopy ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Interscalene Block ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pain Scores

Abstract Introduction: The analgesic comparison of perineural with intravenous dexamethasone on interscalene block for pain management of shoulder arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of perineural with intravenous dexamethasone on interscalene block on the postoperative pain intensity of shoulder arthroscopy.Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2021 for randomized controlled trials (RCTs) assessing the effect of perineural with intravenous dexamethasone on interscalene block for pain control of shoulder arthroscopy. This meta-analysis is performed using the random-effect model.Results: Five RCTs are included in the meta-analysis. Overall, compared with intravenous dexamethasone for shoulder arthroscopy, perineural dexamethasone leads to similar block duration (SMD=0.12; 95% CI=-0.12 to 0.35; P=0.33), pain scores at 12 h (SMD=-0.67; 95% CI=-1.48 to 0.15; P=0.11), pain scores at 24 h (SMD=-0.33; 95% CI=-0.79 to 0.14; P=0.17), opioid consumption (SMD=0.01; 95% CI=-0.18 to 0.19; P=0.95) and nausea/vomiting (OR=0.74; 95% CI=0.38 to 1.44; P=0.38).Conclusions: Perineural and intravenous dexamethasone demonstrated comparable pain control after shoulder arthroscopy when supplemented to interscalene block.

scholarly journals The analgesic evaluation of gabapentin for arthroscopy: a meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Feiri Huang ◽  
Hifan Yang ◽  
Zhongliang Su ◽  
Xiaosheng Gao
Keyword(s):  
Randomized Controlled Trials ◽  
Pain Control ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pain Scores

Abstract Introduction: The efficacy of gabapentin for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of gabapentin versus placebo on the postoperative pain intensity of arthroscopy. Methods We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials (RCTs) assessing the effect of gabapentin versus placebo on pain control of arthroscopy. This meta-analysis is performed using the random-effect model. Results Five RCTs are included in the meta-analysis. Overall, compared with control group for arthroscopy, gabapentin remarkably decreases pain scores at 24 h (Std. MD=-0.68; 95% CI=-1.15 to -0.02; P = 0.21), analgesic consumption (Std. MD=-18.24; 95% CI=-24.61 to -11.88; P < 0.00001), nausea and vomiting (OR = 0.42; 95% CI = 0.21 to 0.84; P = 0.01), but has no obvious influence on pain scores at 6 h (Std. MD=-1.30; 95% CI=-2.92 to 0.31; P = 0.11) or dizziness (OR = 1.12; 95% CI = 0.56 to 2.24; P = 0.75). Conclusions Gabapentin is effective for pain control after arthroscopy.

scholarly journals Intra-articular Magnesium to Alleviate Postoperative Pain After Arthroscopic Knee Surgery: A Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Lijun Shi ◽  
Haiyun Zhu ◽  
Jinhui Ma ◽  
Li-Li Shi ◽  
Fuqiang Gao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Pain Intensity ◽  
Opioid Consumption ◽  
Knee Surgery ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Arthroscopic Knee Surgery ◽  
Randomized Controlled ◽  
Arthroscopic Knee

Abstract Objective: We aimed to evaluate the safety and efficacy of intra-articular (IA) magnesium (Mg) for postoperative pain relief after arthroscopic knee surgery. Methods. We searched PubMed, Embase, Medline, Cochrane library, and Web of Science to identify randomized controlled trials that compared postoperative pain outcomes with or without IA Mg after knee arthroscopy. The primary outcomes were pain intensity at rest and with movement at different postoperative time points and cumulative opioid consumption within 24 hours after surgery. Secondary outcomes included the time to first analgesic request and side effects. Results. In total, 11 studies involving 677 participants met the eligibility criteria. Pain scores at rest and with movement 2, 4, 12, and 24 h after surgery were significantly lower, doses of supplementary opioid consumption were smaller, and the time to first analgesic requirement was longer in the IA Mg group compared with the control group. No significant difference was detected regarding adverse reactions between the groups. Conclusions. Intra-articular magnesium is an effective and safe coadjuvant treatment for relieving postoperative pain intensity after arthroscopic knee surgery.Protocol registration at Prospero: CRD42020156403.

scholarly journals Venous thromboembolism prophylaxis after ambulatory arthroscopic knee surgery: a systematic review and meta-analysis of incidence and risk factors (109)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0025
Author(s):  
Brian Davis ◽  
Todd Phillips ◽  
Olivia Barron ◽  
Brett Heldt ◽  
Andrew Bratsman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Factor ◽  
Knee Arthroscopy ◽  
Meta Analysis ◽  
Significant Risk ◽  
Knee Surgery ◽  
Arthroscopic Knee Surgery ◽  
History Of ◽  
Arthroscopic Knee

Objectives: Over 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the United States annually, yet the reported incidence of venous thromboembolism (VTE) and the use of VTE thromboprophylaxis after ACL reconstruction and other arthroscopic knee surgeries still varies widely. Current VTE risk assessment scores, for example the Caprini score, incorporate arthroscopic surgery as a known risk factor but were not developed for stratification of an outpatient ambulatory surgical patient population. There is no current consensus to guide the orthopedic surgeon in prescribing chemoprophylactic agents after arthroscopic knee surgery. The objectives of this study were to determine the incidence, efficacy, and risk factors for VTE specifically following knee arthroscopic procedures. The null hypotheses of this study was that previously defined risk factors for VTE after ambulatory knee arthroscopy (age over 60 years, BMI greater than 30 kg/m2, tobacco use, prior VTE, malignancy, coagulopathy, oral contraceptive use, family history of coagulopathy, and prolonged tourniquet time greater than 90 minutes) would not reach statistical significance when compared across multiple cohorts. Our hypothesis is that a systematic review and meta-analysis of these variables will reject the null hypotheses with a significance of level of p < .05. Methods: A systematic review and meta-analysis was performed using data collected from 30 cohort and therapeutic trials (721,005 patients) published between January 2000 and April 2020 to compare both the incidence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE) and associated risk factors after knee arthroscopy with or without thromboprophylaxis in adults. Ultrasound, venography, and International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes were deemed acceptable detection methods for VTE. We also performed a meta-analysis of published patient characteristics and risk factors in developing VTE after arthroscopic knee procedures. Individual studies were not evaluated for symptomatic versus asymptomatic VTE detection criteria or methods. Results: Of 331 eligible articles, 6 therapeutic RCTs and 24 cohort studies met the inclusion criteria. Overall incidence of DVT and PE was found to be 0.97% and 0.03% respectively. Analysis of the RCTs was found to support the use of prophylactic anticoagulation in preventing DVTs (relative risk: 0.24, 95% confidence interval [CI]: 0.13-0.44). After analysis of the cohort studies, age greater than 60 years was found to be a statistically significant risk factor for VTE (OR: 1.84, 95% CI: 1.03 – 3.29; p=.04) while a history of malignancy (OR: 2.61, 95% CI: 0.97 – 7.00; p=.06), and history of previous VTE (OR: 4.14, 95% CI: 0.90 – 19.14, p=.07) trended toward significance. Other factors such as BMI greater than 30 kg/m2, tobacco use, tourniquet time, personal or family history of coagulopathy, and oral contraceptive use were not found to be statistically significant risk factors for VTE after knee arthroscopy, however there were limited studies (one to three studies per risk factor) available to distinguish of a majority of these variables. Conclusions: Our results show that the overall incidence of DVT in adults after arthroscopic knee surgery is approaching 1% and that of PE is exceedingly rare, however this may be underestimated if asymptomatic VTE is not identified. Despite a low incidence of VTE after knee arthroscopy, thromboprophylaxis is effective in preventing VTE and trends in risk factors exist in ambulatory sports medicine patients diagnosed with VTE post-operatively. The risk for adverse bleeding events while taking chemoprophylaxis and requires further research. Only rejection of the null hypothesis on age over 60 years was statistically significant, however other defined risk factors may be clinically significant. With these results, we conclude that a preoperative assessment may be warranted in identifying at-risk, high risk, or multi-risk patients for which prophylactic anticoagulation postoperatively after knee arthroscopic procedures may be beneficial. A modified version of the Caprini score specifically stratifying these risk factors in an ambulatory sports medicine population may be valuable to the practicing orthopedic arthroscopic surgeon. More research is warranted for identifying risk factors to better stratify this unique patient population.

scholarly journals Analgesic Effect of Dexamethasone after Arthroscopic Knee Surgery: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6
Author(s):  
Jairo Moyano ◽  
Maria García ◽  
Maria Caicedo
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Knee Surgery ◽  
Controlled Study ◽  
Opioid Use ◽  
Arthroscopic Knee Surgery ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Intraoperative Period ◽  
Arthroscopic Knee

Background.Dexamethasone is sometimes used as a coanalgesic because of its anti-inflammatory properties.Objective. To evaluate opioid use, postoperative pain intensity, and side effects after a single dose of dexamethasone in patients undergoing arthroscopic knee surgery.Methods. In this randomized controlled study patients were randomized to receive either 10 mg of intravenous dexamethasone (DM group) or 0.9% normal saline (NS group) during the intraoperative period. Primary outcomes were pain intensity and total morphine and codeine use after surgery.Results. Seventy-eight patients were included in the study. The DM group showed statistically significant higher pain intensity at the fourth postoperative hour (DM: 3.96/10, standard deviation [SD] 0.54; NS: 2.46/10, SD 0.45;p=0.036). No statistically significant difference in total opioid use (morphine plus codeine) was identified with 15.9 (SD 1.97) codeine tablets used in DM group and 20 (SD 2.14) in NS group (p=0.25).Discussion. Pain intensity tended to decrease in both groups suggesting morphine as the main source of analgesia.Conclusions. Intravenous dexamethasone during the intraoperative period has no clinical impact on postoperative pain intensity during the first 48 h after arthroscopic knee surgery. This trial is registered withR000020892.

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