scholarly journals Serratus anterior plane block for cardiothoracic surgeries: a meta-analysis of randomized trials

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Tarek Abdel hay Mostafa ◽  
Ahmed Mostafa Abd El-Hamid ◽  
Basem Mofreh Abdelgawad ◽  
Dina Hosny Elbarbary
Keyword(s):  
Clinical Trials ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Thoracic Wall ◽  
Serratus Anterior ◽  
Analgesic Drugs ◽  
Thoracic Surgical Procedures ◽  
Pain Scores ◽  
Effective Option ◽  
Anterior Plane

Abstract Background Comparison of serratus anterior plane block to different analgesic methods for anterolateral thoracic wall incisions. Meta-analysis was used to address this concern. Authors systemically searched the MEDLINE, EMBASE, PubMed, and Cochrane databases to identify all published randomized and prospective clinical trials, comparing the SAPB with other methods that used for analgesia in different thoracic surgical procedures and trauma. Results Ten studies were identified for inclusion in this study, involving a total of 735 patients. Meta-analysis showed that, compared with thoracic wall analgesia and PCA methods, the SAPB group resulted in a significant decrease in pain scores, significant decrease in consumption of analgesic drugs, and a significant decrease in the incidence of nausea and vomiting with no difference in the rate of hypotension. Conclusions The use of SAPB in cardiothoracic surgery and trauma is a safe and effective option for thoracic analgesia.

scholarly journals Multicenter longitudinal cross-sectional study comparing effectiveness of serratus anterior plane, paravertebral and thoracic epidural for the analgesia of multiple rib fractures

2020 ◽  
Vol 45 (5) ◽  
pp. 351-356 ◽  
Author(s):  
Laura Beard ◽  
Carl Hillermann ◽  
Emma Beard ◽  
Sue Millerchip ◽  
Rajneesh Sachdeva ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Negative Binomial ◽  
Rib Fractures ◽  
Serratus Anterior ◽  
Regional Analgesia ◽  
Cross Sectional ◽  
Thoracic Epidural ◽  
Pain Scores ◽  
Significant Difference ◽  
Anterior Plane

BackgroundThere is a paucity of data comparing effectiveness of various techniques for pain management of traumatic rib fractures. This study compared the quality of analgesia provided by serratus anterior plane (SAP) catheters against thoracic epidural (TEA) or paravertebral catheters (PA) in patients with multiple traumatic rib fractures (MRFs).Methods354 patients who received either SAP, TEA or PA at two tertiary referral major trauma centers in the UK were included (2016–2018). Primary outcome were change in inspiratory volumes and pain scores. Secondary outcomes included in-hospital mortality, along with the length of stay in hospital and critical care. Data were analyzed using linear, log-binomial and negative binomial regression models.Main resultsAcross all blocks, there was a mean (SD) increase in inspiratory volume postblock of 789.4 mL (479.7). Ninety-eight per cent of all participants reported moderate/severe pain prior to regional analgesia, which was reduced to 34% postblock. There was no significant difference in the change in inspiratory volume or pain scores between the TEA, PA or SAP groups. Overall crude mortality was 13.2% (95% CI 7.8% to 18.7%). In an adjusted analysis and compared with TEA, in-hospital mortality was similar between groups (relative risk (RR) 0.4, 95% CI 0.1 to 1.0) and (RR 0.5, 95% CI 0.2 to 1.6) for SAP and PA, respectively.ConclusionSAP, TEA and PA all appear to offer the ability to reduce pain scores and improve respiratory function.

scholarly journals Safety of Human Papillomavirus 9-Valent Vaccine: A Meta-Analysis of Randomized Trials

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ana Paula Ferreira Costa ◽  
Ricardo Ney Oliveira Cobucci ◽  
Janine Medeiros da Silva ◽  
Paulo Henrique da Costa Lima ◽  
Paulo César Giraldo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Human Papillomavirus ◽  
Adverse Effects ◽  
Randomized Trials ◽  
Web Of Science ◽  
Meta Analysis ◽  
Developed Countries ◽  
Electronic Data ◽  
Tetravalent Vaccine ◽  
Significant Difference

Vaccination against human papillomavirus (HPV) has been progressively implemented in most developed countries for approximately 10 years. In order to increase the protection of the vaccines, a 9-valent vaccine (HPV9) was developed, which provides protection against nine types of the virus. Studies evaluating its safety are rare. Thus, we performed a meta-analysis of three clinical trials assessing adverse effects on women randomly vaccinated with HPV9 or tetravalent vaccine (HPV4), with the objective of analyzing whether the HPV9 is as safe as HPV4. An electronic data search was performed through the PubMed, Embase, Scopus, Web of Science, and SciELO databases. The studies selected 27,465 women who received one of the two vaccines. Pain (OR 1.72; 95% CI 1.62–1.82) and erythema (OR 1.29; 95% CI 1.21–1.36) occurred significantly more in the HPV9 group. However, there was no significant difference between the groups for the following adverse effects: headache (OR 1.07; 95% CI 0.99–1.15), dizziness (OR 1.09; 95% CI 0.93–1.27), and fatigue (OR 1.09; 95% CI 0.91–1.30), and the occurrence of serious events related to vaccination was similarly rare among those vaccinated. Therefore, our findings demonstrate that HPV9 in female patients is as safe as the tetravalent vaccine.

scholarly journals Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing Breast Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Nian-Qiang Hu ◽  
Qi-Qi He ◽  
Lu Qian ◽  
Ji-Hong Zhu
Keyword(s):  
Randomised Controlled Trials ◽  
Breast Surgery ◽  
Meta Analysis ◽  
Oral Morphine ◽  
Mean Difference ◽  
Serratus Anterior ◽  
Randomised Controlled ◽  
Oral Morphine Equivalent ◽  
Anterior Plane ◽  
Morphine Equivalent

Objective. Serratus anterior plane block (SAPB) provides effective thoracic analgesia. This systematic review and meta-analysis was conducted to assess the safety and efficacy of SAPB for postoperative analgesia after breast surgery. Methods. A systematic literature search was performed using Embase, PubMed, Web of Science, and the Cochrane Library for eligible randomised controlled trials. The primary outcomes involved the administration of intraoperative and postoperative opioids. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence for making recommendations. Results. Overall, 13 studies comprising 826 patients met the inclusion criteria (412 in the SAPB group and 414 in the control group). Patients treated with SAPB exhibited a significantly lower postoperative opioid consumption (mean difference, −38.51 mg of oral morphine equivalent; 95% confidence interval (CI), −60.97 to −16.05; P < 0.01 ; I2 = 100%), whereas no difference was observed in the intraoperative opioid consumption (mean difference, −9.85 mg of oral morphine equivalent; 95% CI, −19.52 to −0.18; P = 0.05 ; I2 = 94%). In addition, SAPB significantly decreased the occurrence of postoperative nausea and vomiting (risk ratio, 0.32; 95% CI, 0.19–0.55; P < 0.05 ;I2 = 38%) and reduced pain scores during the postoperative period (1 h: standardised mean difference (SMD), −1.23; 95% CI, −2.00 to −0.45; I2 = 92%; 2 h: SMD, −0.71; 95% CI, −1.00 to −0.41; I2 = 48%; 4 h: SMD, −1.52; 95% CI, −2.77 to −0.27; I2 = 95%; 6 h: SMD, −0.80; 95% CI, −1.51 to −0.08; I2 = 81%; 8 h: SMD, −1.12; 95% CI, −1.98 to −0.27; I2 = 92%; 12 h: SMD, −0.78; 95% CI, −1.21 to −0.35; I2 = 83%; and 24 h: SMD, −0.71; 95% CI, −1.20 to −0.23; I2 = 87%; P < 0.05 for all). Conclusion. SAPB was safe and effective after breast surgery to relieve postsurgical pain. However, additional well-developed trials are required to validate these findings.

Evaluating Mortality with Erythropoietic Stimulating Agents (ESAs) in the Nephrology Setting: The Distinction between Evaluating Trials That Measure Survival as a Primary or Secondary Efficacy Endpoint Versus a Safety Endpoint.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 962-962
Author(s):  
Sara E. Barnato ◽  
Charles L. Bennett ◽  
Kathleen Elverman ◽  
Dennis P. West ◽  
Mark Courtney
Keyword(s):  
Clinical Trials ◽  
Relative Risk ◽  
Randomized Trials ◽  
Randomized Clinical Trials ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Safety Measure ◽  
Significant Safety ◽  
Randomized Controlled ◽  
Efficacy Outcome

Abstract Background: At ASCO 2007, we reported increased mortality risks when ESAs are administered to anemic cancer patients who are receiving chemotherapy when target hemoglobin levels are beyond the correction of anemia. In February 2007, a meta-analysis of nine randomized clinical trials with 5,143 patients published in the Lancet [vol 369; 381–88] identified a statistically significant risk of all cause mortality (relative risk (RR) of 1.17, 95% confidence interval (CI) 1.01, 1.35) when anemic patients with chronic kidney disease received ESAs targeted to higher hemoglobin concentrations (120–150 g/L). A recent report from the RADAR (Research against Adverse Drug Reactions) group raises concern that survival analyses might differ depending on whether survival was evaluated as a measure of efficacy versus a measure of safety. Herein, we re-analyze the data by evaluating randomized clinical trials according to whether or not survival was prospectively included as a primary or secondary efficacy outcome. Methods: Risks of death in randomized controlled clinical trials included in the Lancet meta-analysis were evaluated. We classified those studies based on their mortality outcomes, either as an efficacy outcome or as a safety outcome. Effect estimates for RR and 95% CI were derived from Stata (version 9.1, College Station, TX), calculated with random-effects models and pooled by use of the Dersimonian and Laird method. Results: In studies where survival was measured as an efficacy endpoint, the relative risk of mortality with ESAs targeted to higher hemoglobin levels was 1.27 (1.08, 1.49), a number greater than the relative risk reported in the Lancet meta-analysis. Conclusions: Randomized controlled trials should be included in meta-analyses that evaluate harms only if the relevant safety measure is prospectively included as a primary or secondary efficacy outcome measure in the study protocol. When survival was included as part of the efficacy analysis, a statistically significant safety signal was present. Randomized trials that included harms as a measure of safety did not present a statistically significant safety signal. Including randomized trials that include harms as a safety measure introduce noise and can mask safety signals. Studies: Events: RR (95% CI) Survival included as a primary or secondary efficacy outcome measure: High vs Low Hb Target: Besarab 1998 (n=1233) 183/618 vs 150/615 1.21 (1.01, 1.46) Gouva 2004 (n=88) 4/43 vs 3/45 1.40 (0.33, 5.87) Drueke 2006 (n=602) 31/300 vs 21/302 1.49 (0.87, 2.53) Singh 2006 (n=1432) 52/715 vs 36/717 1.45 (0.96, 2.19) Subtotal (n=3355) 270/1676 vs 210/1679 1.27 (1.08, 1.49) Survival included only as a safety measure: High vs Low Hb Target: Foley 2000 (n=146) 4/73 vs 3/73 1.33 (0.31, 5.75) Furuland 2003 (n=416) 29/216 vs 27/200 0.99 (0.61, 1.62) Roger 2005 (n=154) 0/75 vs 0/79 not estimable Levin 2005 (n=152) 1/74 vs 3/78 0.35 (0.04, 3.30) Parfrey 2005 (n=696) 12/396 vs 20/300 0.45 (0.23, 0.92) Rossert 2006 (n=390) 1/195 vs 6/195 0.17 (0.02, 1.37) Subtotal (n=1954) 47/1029 vs 59/925 0.67 (0.37, 1.19)

scholarly journals Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Events: A Meta-Analysis of Randomized Clinical Trials

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Matteo Monami ◽  
Francesco Cremasco ◽  
Caterina Lamanna ◽  
Claudia Colombi ◽  
Carla Maria Desideri ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cardiovascular Events ◽  
Randomized Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Diabetic Patients ◽  
Cardiovascular Safety ◽  
Type 2 Diabetic Patients ◽  
Receptor Agonists

Objective. Data from randomized clinical trials with metabolic outcomes can be used to address concerns about potential issues of cardiovascular safety for newer drugs for type 2 diabetes. This meta-analysis was designed to assess cardiovascular safety of GLP-1 receptor agonists.Design and Methods. MEDLINE, Embase, and Cochrane databases were searched for randomized trials of GLP-1 receptor agonists (versus placebo or other comparators) with a duration ≥12 weeks, performed in type 2 diabetic patients. Mantel-Haenszel odds ratio with 95% confidence interval (MH-OR) was calculated for major cardiovascular events (MACE), on an intention-to-treat basis, excluding trials with zero events.Results. Out of 36 trials, 20 reported at least one MACE. The MH-OR for all GLP-1 receptor agonists was 0.74 (0.50–1.08),P=.12(0.85 (0.50–1.45),P=.55, and 0.69 (0.40–1.22),P=.20, for exenatide and liraglutide, resp.). Corresponding figures for placebo-controlled and active comparator studies were 0.46 (0.25–0.83),P=.009, and 1.05 (0.63–1.76),P=.84, respectively.Conclusions. To date, results of randomized trials do not suggest any detrimental effect of GLP-1 receptor agonists on cardiovascular events. Specifically designed longer-term trials are needed to verify the possibility of a beneficial effect.

scholarly journals Analgesic Effectiveness of Perioperative Ultrasound-Guided Serratus Anterior Plane Block Combined with General Anesthesia in Patients Undergoing Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis

Pain Medicine ◽  
2020 ◽  
Vol 21 (10) ◽  
pp. 2412-2422 ◽  
Author(s):  
Xiaofei Zhang ◽  
Chao Zhang ◽  
Xiaofeng Zhou ◽  
Wei Chen ◽  
Junhong Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Postoperative Analgesia ◽  
Thoracoscopic Surgery ◽  
Ultrasound Guided ◽  
Serratus Anterior ◽  
Pain Scores ◽  
Tube Removal ◽  
Chest Tube Removal ◽  
Anterior Plane ◽  
Video Assisted Thoracoscopic Surgery

Abstract Objective To investigate whether perioperative ultrasound-guided serratus anterior plane block (SAPB) combined with general anesthesia is more effective and safer than current analgesic techniques for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). Methods PubMed, the Cochrane Library, and EMBASE were searched for clinical trials published up to July 31, 2019. Outcomes, including operative duration, postoperative pain scores, postoperative analgesia use, patient satisfaction with analgesia, time to chest tube removal, length of stay, and adverse effects were analyzed. Results Four clinical trials, including 262 patients, met inclusion criteria. Ultrasound-guided SAPB reduced pain scores at zero, 15, 30, 45, and 60 minutes in the postoperative anesthesia care unit (all P &lt; 0.05) and at one, two, six, 12, and 24 hours in the ward (all P &lt; 0.001). Additionally, postoperatively, morphine consumption at 15 and 30 minutes, overall morphine consumption, and total consumption (morphine plus tramadol) were significantly lower in the SAPB cohort (P  &lt; 0.05). Similarly, postoperative tramadol consumption at one, two, six, 12, and 24 hours was also lower in this cohort (all P  &lt; 0.05). The postoperative consumption of fentanyl, tramadol, and total morphine in patient-controlled analgesia (PCA) at 24 hours was significantly reduced (P &lt; 0.05). Moreover, SAPB provided better patient satisfaction with analgesia (P = 0.0038). However, no statistically significant difference was found in duration of operation, time to chest tube removal, length of stay, or side effects (all P &gt; 0.05). Conclusions Perioperative ultrasound-guided SAPB combined with general anesthesia provided more effective postoperative analgesia after VATS. However, no significant advantage was found regarding side effects.

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