scholarly journals Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Liping Pan ◽  
Hao Wu ◽  
Heng Liu ◽  
Xin Yang ◽  
Zhichao Meng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Motor Strength

Abstract Background Dexmedetomidine has shown potential in pain control in patients undergoing total knee arthroplasty (TKA). However, the combination of nerve block and dexmedetomidine may be a preferred alternative for postoperative analgesia after TKA. The aim of this study was to perform a meta-analysis on existing randomized controlled trials (RCTs) to determine the efficacy and safety of dexmedetomidine as an adjunct to local anesthetics in nerve block after TKA. Methods A literature survey was conducted in the databases of PubMed, Embase, Cochrane Library, Web of science, and ScienceDirect for the RCTs completed before February 1st, 2020 that met pre-specified inclusion criteria. The primary outcomes included the pain scores, duration of analgesia, opioid consumption within 24 h postoperatively, and the level of patient satisfaction. The secondary outcomes included the motor strength, degree of sedation, postoperative nausea and vomiting, and other related complications. The methodological quality was assessed by the Cochrane risk of bias tool. Results The initial literature search yielded 143 studies, out of which seven studies met the inclusion criteria. The pooled data indicated that dexmedetomidine combined with local anesthetics in nerve block in TKA decreased the postoperative pain scores at rest as well as at motion (SMD = − 1.01 [95% CI − 1.29 to − 0.72], p < 0.01; SMD = − 1.01 [− 1.25 to − 0.77], p < 0.01) respectively, decreased the total opioid consumption within 24 h (SMD = − 0.63 [− 0.86 to − 0.40], p < 0.01), prolonged the duration of analgesia (SMD = 0.90 [0.64 to 1.17], p < 0.01), improved motor strength (SMD = 0.23 [0.01 to 0.45], p = 0.04), improved the degree of sedation (SMD = 0.94 [0.70 to 1.18], p < 0.01), and increased the level of patient satisfaction (SMD = 0.88 [0.60 to 1.17], p < 0.01) without increasing nausea and vomiting (RD = − 0.05 [− 0.11 to 0.01], p = 0.14), as well as other complications (RD = − 0.01 [− 0.08 to 0.07], p = 0.89), compared with local anesthetics alone. Conclusions It is effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioid consumption, prolong analgesic duration, and increase patient satisfaction without increasing related complications. Based on the quality of evidence, this meta-analysis recommends that dexmedetomidine can be used in a regular treatment regimen and as an adjunct addition to local anesthetics in nerve block for patients undergoing TKA. Registration This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews) and the registering number was CRD42020169171.

scholarly journals Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Liping Pan ◽  
Hao Wu ◽  
Heng Liu ◽  
Xin Yang ◽  
Zhichao Meng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Motor Strength

Abstract Background: Dexmedetomidine has shown potential in pain control in patients undergoing Total Knee Arthroplasty (TKA). However, the combination of nerve block and dexmedetomidine may be a preferred alternative for postoperative analgesia after TKA. The aim of this study was to perform a meta-analysis on existing randomized controlled trials (RCTs) to determine the efficacy and safety of dexmedetomidine as an adjunct to local anesthetics in nerve block after TKA.Methods: A literature survey was conducted in the databases of PubMed, Embase, Cochrane Library, Web of science and ScienceDirect for the RCTs completed before February 1st, 2020 that met pre-specified inclusion criteria. The primary outcomes included the pain scores, duration of analgesia, opioid consumption within 24 hours postoperatively, and the level of patient satisfaction. The secondary outcomes included the motor strength, degree of sedation, postoperative nausea and vomiting, and other related complications. The methodological quality was assessed by the Cochrane risk of bias tool. Results: The initial literature search yielded 143 studies, out of which seven studies met the inclusion criteria. The pooled data indicated that dexmedetomidine combined with local anesthetics in nerve block in TKA decreased the postoperative pain scores at rest as well as at motion (SMD=-1.01[95%CI, -1.29 to -0.72], p<0.01; SMD=-1.01[-1.25 to -0.77], p<0.01) respectively, decreased the total opioid consumption within 24 hours(SMD=-0.63[-0.86 to -0.40],p<0.01), prolonged the duration of analgesia (SMD = 0.90 [0.64 to 1.17], p < 0.01), improved motor strength (SMD = 0.23 [0.01 to 0.45], p = 0.04), improved the degree of sedation (SMD = 0.94 [0.70 to 1.18], p < 0.01), and increased the level of patient satisfaction (SMD = 0.88 [0.60 to 1.17], p < 0.01) without increasing nausea and vomiting (RD = -0.05 [-0.11 to 0.01], p = 0.14), as well as other complications (RD = -0.01 [-0.08 to 0.07], p=0.89), compared with local anesthetics alone.Conclusions: It is effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioid consumption, prolong analgesic duration and increase patient satisfaction without increasing related complications. Based on the quality of evidence, this meta-analysis recommends that dexmedetomidine can be used in a regular treatment regimen and as an adjunct addition to local anesthetics in nerve block for patients undergoing TKA.Registration: This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews) and the registering number was CRD42020169171.

scholarly journals Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Liping Pan ◽  
Hao Wu ◽  
Heng Liu ◽  
Xin Yang ◽  
Zhichao Meng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Randomized Controlled Trials ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Motor Strength

Abstract Background: Dexmedetomidine showed some potential in pain control in patients undergoing Total Knee Arthroplasty (TKA). Nerve block is a preferable alternative for postoperative analgesia after TKA, on which dexmedetomidine had an effect controversially. This study aimed to meta-analyze the available randomized controlled trials to determine the efficacy and safety of dexmedetomidine as an adjunct to local anesthetics in nerve block after TKA. Methods: PubMed, Embase, Cochrane Library, Web of science and ScienceDirect databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to February 1 st , 2020 . The primary outcomes included pain scores, duration of analgesia, total opioids consumption in 24 hours postoperatively, and patient satisfaction. The second outcomes were motor strength, sedation degree and postoperative nausea and vomiting, and other related complications. The methodological quality was assessed by the Cochrane risk of bias tool. Results: The initial search yielded 143 studies, of which 7 met the inclusion criteria finally. The pooled data indicated that dexmedetomidine combined with local anesthetics in nerve block in TKA could decrease postoperative pain scores at rest (SMD=-1.01[95%CI, -1.29 to -0.72], p<0.01) and at motion(SMD=-1.01[-1.25 to -0.77], p<0.01,), decrease the total opioids consumption within 24 hours(SMD=-0.63[-0.86 to -0.40], p<0.01), prolong the analgesia duration(SMD=0.90[0.64 to 1.17], p<0.01), improve motor strength(SMD=0.23[0.01 to 0.45], p=0.04) and the sedation degree (SMD=0.94[0.70 to 1.18], p<0.01), and increase the patient satisfaction(SMD=0.88[0.60 to 1.17], p<0.01) without adding nausea and vomiting(RD=-0.05[-0.11 to 0.01],p=0.14), and other related complications(RD=-0.01[-0.08 to 0.07],p=0.89), compared with local anesthetics alone in nerve block. Conclusions: It was effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioids consumption, prolong analgesic duration and increase patient satisfaction without increasing related complications. Based on the quality evidence we got, we recommended dexmedetomidine as a regular regimen in nerve block for patients undergoing TKA. Registration: This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews) and the registering number was CRD42020169171.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background: Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries.Methods: A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Results: A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia ( RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV).Conclusions: Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Ultrasound-guided Erector Spinae Plane Block for postoperative analgesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Jiao Huang ◽  
Jing Chen Liu
Keyword(s):  
Randomized Controlled Trials ◽  
Postoperative Analgesia ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Erector Spinae ◽  
Controlled Trials ◽  
Ultrasound Guided ◽  
Randomized Controlled ◽  
Erector Spinae Plane Block ◽  
Pain Scores

Abstract Background Ultrasound-guided Erector Spinae Plane Block (ESPB) has been increasingly applied in patients for postoperative analgesia. Its safety and effectiveness remain uncertain. This meta-analysis aimed to determine the clinical safety and efficacy of ultrasound-guided ESPB in adults undergoing general anesthesia (GA) surgeries. Methods A systematic databases search was conducted in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing ESPB with control or placebo. Primary outcome was iv. opioid consumption 24 h after surgery. Standardized mean differences (SMDs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model.Results A total of 11 RCTs consisting of 540 patients were included. Ultrasound -guided ESPB showed a reduction of iv. opioid consumption 24 h after surgery (SMD=-2.15; 95% confidence interval (CI) -2.76 to -1.5,p<0.00001), pain scores at 1st hour (SMD=-0.97;95% CI -1.84 to -0.1,p=0.03) and pain scores at 6th hour (SMD=-0.64,95% CI -1.05 to -0.23,p=0.002), Also, it lessened the number of patients who required postoperative analgesia (RR=0.41,95% CI 0.25 to 0.66,p=0,0002) and time to first rescue analgesia (SMD=4.56,95% CI 1.89 to 7.22, p=0.0008). Differences were not significant with the pain score at 12th hour,24th hour and postoperative nausea and vomiting (PONV). Conclusions Ultrasound-guided ESPB provides postoperative analgesic efficacy in adults undergoing GA surgeries with no increase in PONV.

scholarly journals Usefulness of surgical pleth index-guided analgesia during general anesthesia: a systematic review and meta-analysis of randomized controlled trials

2018 ◽  
Vol 46 (11) ◽  
pp. 4386-4398 ◽  
Author(s):  
Young Ju Won ◽  
Byung Gun Lim ◽  
Young Sung Kim ◽  
Mido Lee ◽  
Heezoo Kim
Keyword(s):  
Postoperative Pain ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Opioid Consumption ◽  
Controlled Trials ◽  
Intergroup Difference ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Extubation Time

Objective Previous studies comparing surgical pleth index (SPI)-guided and conventional analgesia have shown differing results. Therefore, we compared the intraoperative opioid requirement, extubation time, postoperative pain scores, and perioperative adverse events between these two modalities. Methods A comprehensive literature search was conducted to identify randomized controlled trials comparing the intraoperative opioid requirement and other outcomes between the two modalities. The mean difference (MD) or the pooled risk ratio and corresponding 95% confidence interval (CI) were used for analysis. A heterogeneity (I2) assessment was performed. Results Six randomized controlled trials comparing 463 patients were included. Intraoperative opioid consumption was significantly lower in the SPI-guided than conventional analgesia group (standardized MD, −0.41; 95% CI, −0.70 to −0.11; I2 = 53%). No significant intergroup difference was observed in the pain score on the first postoperative day or the incidence of perioperative adverse events. The extubation time was considerably shorter in the SPI-guided than conventional analgesia group (MD, −1.91; 95% CI, −3.33 to −0.49; I2 = 67%). Conclusions Compared with conventional analgesia, SPI-guided analgesia can reduce intraoperative opioid consumption and facilitate extubation. Moreover, no intergroup difference was observed in the degree of postoperative pain or incidence of perioperative adverse events.

scholarly journals Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials

2019 ◽  
Vol 47 (2) ◽  
pp. 515-527
Author(s):  
Xiufang Xu ◽  
Dongqiong Ni ◽  
Yuping Lu ◽  
Xuan Huang
Keyword(s):  
Patient Satisfaction ◽  
Detection Rate ◽  
Water Exchange ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Intubation Rate ◽  
Cecal Intubation ◽  
Randomized Controlled ◽  
Adenoma Detection ◽  
Cecal Intubation Rate

Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.

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