Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality, length of stay, and the prevalence of delirium, acute myocardial infarction, and pneumonia for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia. The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is significantly superior to general anesthesia regarding blood loss in patients undergoing hip fracture surgery. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to to clarify this issue.

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Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

10.21203/rs.2.17433/v3 ◽

2020 ◽

Author(s):

Xinxun Zheng ◽

Yuming Tang ◽

Yuan Gao ◽

Zhiheng Liu

Keyword(s):

Hip Fracture ◽

Blood Loss ◽

General Anesthesia ◽

Sample Size ◽

Meta Analysis ◽

Neuraxial Anesthesia ◽

Perioperative Outcomes ◽

Hip Fracture Surgery ◽

Evidence Quality ◽

Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is associated with a reduced blood loss in patients undergoing hip fracture surgery compared to general anesthesia. However, this result was underpowered. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue

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Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

10.21203/rs.2.17433/v4 ◽

2020 ◽

Author(s):

Xinxun Zheng ◽

Yuming Tang ◽

Yuan Gao ◽

Zhiheng Liu

Keyword(s):

Hip Fracture ◽

Blood Loss ◽

General Anesthesia ◽

Multiple Testing ◽

Meta Analysis ◽

Perioperative Outcomes ◽

Bonferroni Correction ◽

Hip Fracture Surgery ◽

Evidence Quality ◽

Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery.Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were conducted using a Bonferroni correction and the leave-one-out method. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The outcomes for the meta-analysis showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia, and there was a significant difference in blood loss between the two groups (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). However, after applying the Bonferroni correction for multiple testing, all the adjusted p-values were above the significant threshold of 0.05. The evidence quality for each outcome evaluated by the GRADE system was low.Conclusions: In summary, our present study demonstrated that there might be a difference in blood loss between patients receiving neuraxial and general anaesthesia, however, this analysis was not robust to adjustment for multiple testing and therefore at high risk for a type I error. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

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Comparative Efficacy of Neuraxial and General anesthesia for hip fracture surgery: A meta-analysis of randomized clinical trials

10.21203/rs.2.17433/v2 ◽

2020 ◽

Author(s):

Xinxun Zheng ◽

Yuming Tang ◽

Yuan Gao ◽

Zhiheng Liu

Keyword(s):

Hip Fracture ◽

Blood Loss ◽

General Anesthesia ◽

Sample Size ◽

Meta Analysis ◽

Neuraxial Anesthesia ◽

Perioperative Outcomes ◽

Hip Fracture Surgery ◽

Evidence Quality ◽

Fracture Surgery

Abstract Background: The choice of anesthesia technique remains debatable in patients undergoing surgical repair of hip fracture. This meta-analysis was performed to compare the effect of neuraxial (epidural/spinal) versus general anesthesia on perioperative outcomes in patients undergoing hip fracture surgery. Methods: Medline, Cochrane Library, Science-Direct, and EMBASE databases were searched to identify eligible studies focused on the comparison between neuraxial and general anesthesia in hip fracture patients between January 2000 and May 2019. Perioperative outcomes were extracted for systemic analysis. The sensitivity analyses were performed by the leave-one-out approach. The evidence quality for each outcome was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Nine randomized controlled trials (RCTs) including 1084 patients fulfilled our selection criteria. The results showed that there were no significant differences in the 30-day mortality (OR = 1.34, 95% CI 0.56, 3.21; P = 0.51), length of stay (MD = -0.65, 95% CI -0.32, 0.02; P =0.06), and the prevalence of delirium (OR = 1.05, 95% CI 0.27, 4.00; P = 0.95), acute myocardial infarction (OR = 0.88, 95% CI 0.17, 4.65; P = 0.88), deep venous thrombosis (OR = 0.48, 95% CI 0.09, 2.72; P = 0.41), and pneumonia (OR = 1.04, 95% CI 0.23, 4.61; P = 0.96) for neuraxial anesthesia compared to general anesthesia. There was a significant difference in terms of blood loss in favor of the neuraxial anesthesia (MD = -137.8, 95% CI -241.49, -34.12; p = 0.009). The evidence quality for each outcome evaluated by the GRADE system was low. Conclusions: In summary, our present study demonstrated that neuraxial anesthesia is associated with a reduced blood loss in patients undergoing hip fracture surgery compared to general anesthesia. Due to small sample size and enormous inconsistency in the choice of outcome measures, more high-quality studies with large sample size are needed to clarify this issue.

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Maternal and Neonatal Effect of Fentanyl as a Premedication before Induction of General Anesthesia in Cesarean Surgery: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Current Women s Health Reviews ◽

10.2174/1573404815666190111151651 ◽

2019 ◽

Vol 15 (4) ◽

pp. 232-237

Author(s):

Mir Hadi Musavi ◽

Behzad Jodeiri ◽

Keyvan Mirnia ◽

Morteza Ghojazadeh ◽

Zeinab Nikniaz

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Cesarean Section ◽

General Anesthesia ◽

Apgar Score ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Intravenous Fentanyl ◽

Neonatal Effect ◽

Fentanyl Group

Background: Although, some clinical trials investigated the maternal and neonatal effect of fentanyl as a premedication before induction of general anesthesia in cesarean section, to the best of our knowledge, there is no systematic review to summarize these results. Objectives: The present systematic review and meta-analysis evaluated the maternal and neonatal effect of intravenous fentanyl as a premedication before induction of general anesthesia in cesarean section. Methods: The databases of Pubmed, Embase, Scopus and Cochrane library were searched till July 2017 to identify randomized clinical trials which evaluated the effects of intravenous fentanyl as a premedication before induction of general anesthesia compared with placebo on neonate first and fifth minute Apgar score and maternal heart rate and mean arterial pressure (MAP) in cesarean section. Standard Mean difference (SMD) was calculated and I-square statistic test was used for heterogeneity analysis. Results: The present systematic review and meta-analysis consisted of three clinical trials including 180 women in labor. Considering the results of meta-analysis, there is no significant differences between fentanyl and placebo in the case of Apgar score at 1 minute; however, the Apgar score of 5 minutes was significantly lower in fentanyl group compared with placebo (SMD -0.68, 95%CI: - 0.98, -0.38, p<0.001). In the term of maternal hemodynamics, the heart rate (SMD -0.43, 95%CI: - 0.72, -0.13, p=0.004) and MAP (SMD -0.78, 95% CI: -1.09, -0.48, p<0.001) in fentanyl group were significantly lower compared with placebo group. Conclusion: The present meta-analysis showed that using intravenous fentanyl as a premedication before induction of general anesthesia had adverse effects on neonate Apgar score. However, it had positive effects on preventing adverse consequences of intubation on maternal hemodynamics.

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