Pain and Anxiety Levels Using Conventional versus Computer-Controlled Local Anesthetic Systems in Pediatric Patients: A Meta-Analysis

2020 ◽  
Vol 44 (6) ◽  
pp. 371-399
Author(s):  
Amaury Pozos-Guillén ◽  
Edith Loredo-Cruz ◽  
Vicente Esparza-Villalpando ◽  
Ricardo Martínez-Rider ◽  
Miguel Noyola-Frías ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Meta Analysis ◽  
Pain Scale ◽  
Anesthetic Technique ◽  
Randomized Controlled Clinical Trials ◽  
Significant Difference ◽  
Prisma Statement ◽  
Lower Pain ◽  
Computer Controlled ◽  
Anxiety Levels

The objective of this systematic review and meta-analysis was to compare the pain/anxiety levels associated with the anesthetic process by conventional and computer-controlled delivery systems (CCDS) in children. Four electronic databases (PubMed, EMBASE, Scopus, Google Scholar, and Dentistry & Oral Science Source/EBSCO) were comprehensively explored for eligible studies, in English or Spanish, published from January 1995 to December 2019. A systematic literature review and meta-analysis were conducted according to the PRISMA statement, including only randomized controlled clinical trials. An exhaustive search was performed in different electronic databases under a specific PICO-posed question. Relevant studies were selected based on titles and abstracts, and the full texts were retrieved. From these articles, important information was extracted. Wand demonstrated significantly lower pain than the conventional injection did. In the subgroup by pain scale analysis, the Facial Image Scale and Wong-Baker Faces Pain Scale showed a significant difference in favor of the CCDS. In general, the reviewed evidence shows that less perceived pain and anxiety occur when the local anesthetic technique is performed with a CCDS than with the traditional technique.

scholarly journals Prostate cancer topography and tumour conspicuity on multiparametric magnetic resonance imaging: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Pranav Satish ◽  
Alex Freeman ◽  
Daniel Kelly ◽  
Alex Kirkham ◽  
Clement Orczyk ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Peripheral Zone ◽  
Transitional Zone ◽  
Dynamic Contrast Enhancement ◽  
Significant Difference ◽  
Prisma Statement ◽  
Tumour Location ◽  
The Relationship

Introduction The implications of tumour location on mpMRI conspicuity are not fully understood. Identifying topographical correlates that influence conspicuity may improve outcomes. Here, we present the first systematic review and meta-analysis describing the effect of tumour location on prostate cancer conspicuity on mpMRI. Methods Medline, PubMed, EMBASE and Cochrane databases were systematically searched and results were assessed as per the PRISMA statement. Differential tumour conspicuity on mpMRI was compared between cancers in the peripheral zone (PZ), transitional zone (TZ), base, apex, anterior and posterior. Meta-analysis was conducted to compare diagnostic odds ratios (DOR) of mpMRI detection for tumours in the PZ and TZ. PROSPERO registration: CRD42021228087. Results Thematic synthesis showed apical and basal tumours had reduced conspicuity compared to mid-gland tumours. Cancer in the TZ demonstrated increased conspicuity on T2-weighted imaging, whilst PZ cancers had higher conspicuity on diffusion-weighted and dynamic contrast enhancement imaging. mpMRI had better diagnostic accuracy for PZ lesions, albeit higher specificity for TZ lesions. Meta-analysis showed an increased DOR for PZ tumours (OR: 7.206 [95% CI: 4.991;10.403], compared to TZ (OR: 5.310 [95% CI: 3.082; 9.151]). However, the test for subgroup differences was not significant (p = 0.2743). Conclusions Cancer in the apex or base of the prostate may be less conspicuous than mid-gland tumours. Similarly, TZ cancer appears to have reduced conspicuity compared to PZ cancer, however, meta-analysis did not show a significant difference between DOR. Future larger studies with prospective datasets are required to clarify the relationship between tumour position and conspicuity.

scholarly journals https://painphysicianjournal.com/current

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. 335-348
Author(s):  
Nicholas Van Halm-Lutterodt
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Neck Pain ◽  
Functional Status ◽  
Spinal Stenosis ◽  
Local Anesthetic ◽  
Meta Analysis ◽  
Chronic Neck Pain ◽  
Epidural Injections ◽  
Significant Difference

Background: Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin. Objectives: To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain. Study Design: Systematic review and meta-analysis. Methods: A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage. Results: Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], –0.006; 95% confidence interval (CI), –0.275 to 0.263; P = 0.963; I2 = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, –1.231 to 1.549; P = 0.823; I2 = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, –0.093; 95% CI, –5.952 to 5.766; P = 0.975; I2 = 0.0% at 12 months). Limitations: Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies. Conclusions: The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain. Key words: Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial

Effects of short-wave therapy in patients with knee osteoarthritis: a systematic review and meta-analysis

2016 ◽  
Vol 31 (5) ◽  
pp. 660-671 ◽  
Author(s):  
Haiming Wang ◽  
Chi Zhang ◽  
Chengfei Gao ◽  
Siyi Zhu ◽  
Lijie Yang ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Strength Function ◽  
Knee Extensor ◽  
Short Wave ◽  
Pain Scale ◽  
Control Group ◽  
Continuous Variables ◽  
Significant Difference ◽  
Evidence Database

Objective: To evaluate the efficacy and safety of short-wave therapy with sham or no intervention for the management of patients with knee osteoarthritis. Methods: We searched the following databases from their inception up to 26 October 2016: MEDLINE, CENTRAL, EMBASE, Physiotherapy Evidence Database, CINAHL and OpenGrey. Studies included randomized controlled trials compared with a sham or no intervention in patients with knee osteoarthritis. The results were calculated via standardized mean difference (SMD) and risk ratio for continuous variables outcomes as well as dichotomous variables, respectively. Heterogeneity was explored by the I2 test and inverse-variance random effects analysis was applied to all studies. Results: Eight trials (542 patients) met the inclusion criteria. The effect of short-wave therapy on pain was found positive (SMD, −0.53; 95% CI, −0.84 to −0.21). The pain subgroup showed that patients received pulse modality achieved clinical improvement (SMD, –0.83; 95% CI, –1.14 to −0.52) and the pain scale in female patients decreased (SMD, −0.53; 95% CI, −0.98 to −0.08). In terms of extensor strength, short-wave therapy was superior to the control group ( p < 0.05, I2 = 0%). There was no significant difference in the physical function (SMD, −0.16; 95% CI, −0.36 to 0.05). For adverse effects, there was no significant difference between the treatment and control group. Conclusion: Short-wave therapy is beneficial for relieving pain caused by knee osteoarthritis (the pulse modality seems superior to the continuous modality), and knee extensor muscle combining with isokinetic strength. Function is not improved.

scholarly journals Comparison of Pain Perception Using Conventional Versus Computer-Controlled Intraligamentary Local Anesthetic Injection for Extraction of Primary Molars

2019 ◽  
Vol 66 (2) ◽  
pp. 69-76
Author(s):  
Meenu Mittal ◽  
Radhika Chopra ◽  
Ashok Kumar ◽  
Dhirendra Srivastava
Keyword(s):  
Heart Rate ◽  
Conventional Method ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Controlled Trial ◽  
Pain Scale ◽  
Primary Molars ◽  
Primary Molar ◽  
Alternative Means ◽  
Computer Controlled

This study was conducted to compare pain perception of intraligamentary anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLADS) versus a conventional intraligamentary injection for extraction of primary molars. A randomized controlled trial was designed where 82 children requiring 102 primary molar extractions were given ILA of 2% lidocaine with 1:80,000 epinephrine with either the conventional method or a CCLADS. Pain during injection and extraction was assessed using the Sound, Eye, Motor (SEM) scale and heart rate recording. Faces Pain Scale–Revised (FPS) scores were self-reported by patients. The Mann-Whitney test was used for evaluation of FPS and SEM scores and Student's t test for evaluation of heart rate readings. Heart rate values during injection were found to be higher, but not statistically significantly higher (p = .077), for conventional injection versus CCLADS; however, heart rate values during extraction were significantly higher for the conventional method (p = .009). Both FPS and SEM values were found to be significantly higher for conventional ILA technique (p &lt; .05). ILA can be an effective alternative means of anesthesia for primary molar extractions, and CCLADS devices can make ILA more effective and less painful.

scholarly journals Effects of palonosetron and ondansetron on preventing nausea and vomiting after laparoscopic surgery

2017 ◽  
Vol 46 (1) ◽  
pp. 411-420 ◽  
Author(s):  
Qili Liu ◽  
Chengmao Zhou ◽  
Zeqing Bao ◽  
Yu Zhu
Keyword(s):  
Laparoscopic Surgery ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Time Intervals ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Cochrane Library

Background This meta-analysis was performed to evaluate the efficacy and safety of palonosetron and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery with general anesthesia. Methods We searched for randomized controlled clinical trials in PubMed, Embase, and The Cochrane Library. Results Nine studies were enrolled in this meta-analysis and showed no statistically significant difference between palonosetron and ondansetron in the prevention of PONV in the first 24 hours after surgery (relative risk [RR], 0.62; 95% confidence interval [CI], 0.35–1.10). Palonosetron more effectively prevented vomiting at various time intervals during the first 24 hours postoperatively than did ondansetron: 0–2 hours (RR, 0.45; 95% CI, 0.26–0.78), 2–6 hours (RR, 0.74; 95% CI, 0.39–1.40), and 6–24 hours (RR, 1.20; 95% CI, 0.55–2.64). No significant differences in side effects were found between palonosetron and ondansetron (RR, 0.67; 95% CI, 0.40–1.14). Conclusion This meta-analysis demonstrated that palonosetron is not more efficacious than ondansetron in the prevention of early PONV. However, palonosetron was more efficacious than ondansetron in the prevention of vomiting after laparoscopic surgery.

Risk of fatigue with the targeted therapy for renal cell carcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20611-e20611
Author(s):  
Bilal Iqbal ◽  
Shenhong Wu
Keyword(s):  
Renal Cell Carcinoma ◽  
Targeted Therapy ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Fixed Effects ◽  
Meta Analysis ◽  
High Grade ◽  
Fixed Effects Model ◽  
Randomized Controlled Clinical Trials ◽  
Significant Difference

e20611 Background: Fatigue is one of the major side effects associated with targeted therapeutic agents in the treatment of renal cell carcinoma (RCC), and has negatively affected the optimal use of these drugs. Currently the risk of fatigue has not been well defined. We performed a systematic review and meta-analysis of published randomized controlled clinical trials (RCT) to determine the risk of fatigue in RCC patients treated with targeted therapy. Methods: Databases including PUBMED, Web of Science, and abstracts presented at the American Society of Clinical Oncology meetings up to October, 2012 were searched to identify relevant studies. Eligible studies included prospective RCTs in which a targeted therapy was compared to a control of non-targeted therapy (placebo or interferon) with data available. Incidences and relative risk (RR) were calculated using a random- or fixed-effects model depending on the heterogeneity of the included studies. Results: A total of 5,192 RCC patients (targeted therapy: 3023, control: 2092) from 11 RCTs were selected for analysis. The overall incidences of all-grade and high-grade (ie, grade 3 or above) fatigue were 45.4% (95% CI: 33.0-58.5%) and 7.6% (95% CI: 4.1-13.5%) respectively. The incidences varied significantly among different agents (P<0.001). In comparison with overall controls, the targeted therapy did not significantly increase the risk of all-grade (RR=1.07, 95% CI: 1.0-1.35, p=0.055) or high-grade fatigue (RR= 1.01, 95% CI: 0.68-1.50, P=0.95). However, the targeted therapy significantly increased the risk of all-grade fatigue (RR 1.60, 95% CI: 1.40-2.32; P<0.001), but not high-grade fatigue (RR 1.74, 95% CI: 0.91-3.32; P=0.095) when compared to placebo. There was no significant difference between the targeted therapy and interferon in the risk of all-grade (RR 1.02, 95% CI: 0.90-1.14; P=0.90) or high-grade fatigue (RR 0.86, 95% CI: 0.55-1.36; P=0.53). Conclusions: The targeted therapy may significantly increase the risk of fatigue in a magnitude comparable to interferon.

scholarly journals Assessment of computer-controlled local anesthetic delivery system for pain control during restorative procedures: A randomized controlled trial

2019 ◽  
Vol 13 (4) ◽  
pp. 298-304
Author(s):  
Hrishikesh Saoji ◽  
Mohan Thomas Nainan ◽  
Naveen Nanjappa ◽  
Mahesh Ravindra Khairnar ◽  
Meeta Hishikar ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Delivery System ◽  
Local Anesthetic ◽  
Pain Perception ◽  
Controlled Trial ◽  
Conventional Group ◽  
Lower Pain ◽  
Computer Controlled ◽  
Recovery From Anesthesia ◽  
Time Required

Background. Local anesthesia is given to decrease pain perception during dental treatments, but it may itself be a reason for pain and aggravate the dental fear. Computer-controlled local anesthetic delivery system (CCLADS) is one of the alternatives for decreasing the patients’ pain during local anesthesia. This study compared the time required for the recovery from anesthesia, pain/discomfort during injection and pain/discomfort 24 hours after administering local anesthesia with CCLADS, a standard self-aspirating syringe and a conventional disposable 2-mL syringe. Methods. The study was conducted on 90 subjects (an age group of 20-40 years), who suffered from sensitivity during cavity preparation. They were randomly divided into three groups of 30 individuals each to receive intraligamentary anesthesia (2% lignocaine with 1:80,000 adrenaline) using either of the three techniques: CCLADS, a standard self-aspirating syringe, or a conventional disposable 2-mL syringe. The onset of anesthesia, time required for recovery from anesthesia (in minutes), pain/discomfort during injection and pain/discomfort 24 hours after administering local anesthesia were recorded. Results. The time required for the onset of anesthesia and recovery from anesthesia was shorter with CCLADS (4.83±2.31 and 34.2±1.895, respectively) as compared to the standard self-aspirating group (10.83±1.90 and 43.5±7.581, respectively) and the conventional group (11.00±2.03 and 43.5±6.453, respectively) (P<0.001). The patients in the CCLADS group experienced no pain during local anesthesia administration as compared to the patients in the self-aspirating and conventional groups. The CCLADS and self-aspirating groups showed lower pain response as compared to the conventional group for pain after 24 hours. Conclusion. CCLADS can be an effective and pain-free alternative to conventional local anesthetic procedures.

The Effect of the COVID-19 Pandemic on Health Care Workers’ Anxiety Levels: A Meta-Analysis (Preprint)

2021 ◽  
Author(s):  
Lunbo Zhang ◽  
Ming Yan ◽  
Kaito Takashima ◽  
Wenru Guo ◽  
Yuki Yamada
Keyword(s):  
Health Care ◽  
Publication Bias ◽  
Health Care Workers ◽  
Meta Analysis ◽  
Anxiety State ◽  
Significant Heterogeneity ◽  
Moderator Analysis ◽  
Care Workers ◽  
Significant Difference ◽  
Anxiety Levels

BACKGROUND The COVID-19 pandemic has been declared a public health emergency of international concern; this has caused excessive anxiety among health care workers. In addition, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable findings.  OBJECTIVE This paper presents the protocol for a meta-analysis with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased due to the COVID-19 pandemic, and (2) to investigate whether there has been an increase in publication bias.  METHODS All related studies that were published/released from 2015 to 2020 will be searched in electronic databases (Web of Science, PubMed, PsyArXiv, and medRxiv). The risk of bias in individual studies will be assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. The heterogeneity of the studies will be assessed using the I2 statistic. The effect size (prevalence rates of anxiety) and a 95% CI for each paper will also be calculated. We will use a moderator analysis to test for the effect of COVID-19 on health care workers’ anxiety levels and detect publication bias in COVID-19 studies. We will also assess publication bias using the funnel plot and Egger regression. In case of publication bias, if studies have no homogeneity, the trim-and-fill procedure will be applied to adjust for missing studies. RESULTS The pooled meta-analysis prevalence was 35.3% (95% CI: 32.2%−38.4%). The moderator analysis revealed no significant difference between articles related to COVID-19 and those unrelated to COVID-19 (p = 0.831). Moreover, no significant difference was found between articles related to COVID-19 and preprints (p = 0.981). Significant heterogeneity was found in each subgroup. Egger’s tests revealed publication bias in articles related to COVID-19 and preprints (p < 0.001).  CONCLUSIONS Our study found no significant differences in the effect sizes (prevalence of anxiety) between studies related and those unrelated to COVID-19. Concluding whether the anxiety state of health care workers is altered by the COVID-19 pandemic currently is difficult. However, we have strong evidence that their anxiety levels are always high, although this could also be a false positive caused by a large publication bias. Moreover, without comparing the results with those of non-healthcare workers, we cannot be sure that their anxiety is particularly high. The present study highlights the need to generalize valid and reliable measurements to more accurately examine health care workers’ anxiety in the future. Furthermore, we found a large publication bias in studies; however, the quality of the studies is relatively stable and reliable. INTERNATIONAL REGISTERED REPORT RR2-10.2196/24136

scholarly journals Efficacy and Safety of Chinese Medicinal Herbs for the Treatment of Hyperuricemia: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-12 ◽  
Author(s):  
Jianping Lin ◽  
Shaoqing Chen ◽  
Shuzhen Li ◽  
Meili Lu ◽  
Yanan Li ◽  
...  
Keyword(s):  
Western Medicine ◽  
Meta Analysis ◽  
Medicinal Herbs ◽  
Chinese Medicinal Herbs ◽  
Efficacy And Safety ◽  
Systematic Assessment ◽  
Randomized Controlled Clinical Trials ◽  
Significant Difference ◽  
Funnel Plots ◽  
Better Than

Background. Chinese medicinal herbs may be useful for the treatment of hyperuricemia, but there has been no systematic assessment of their efficacy and safety.Objectives. To systematically assess the efficacy and safety of Chinese medicinal herbs for the treatment of hyperuricemia.Methods. Six electronic databases were searched from their inception to December 2015. Randomized controlled clinical trials (RCTs) were included. Cochrane criteria were applied to assess the risk of bias. Data analysis was performed using RevMan software version 5.2.Results. Eleven RCTs with 838 patients were included. There was no significant difference in serum uric acid between Chinese medicinal herbs and traditional Western medicine (SME: 0.19, 95% CI: −0.04 to 0.43;p=0.10). In terms of overall efficacy, the Chinese medicinal herbs were significantly superior to Western medicine (RR: 1.11; 95% CI: 1.04 to 1.17;p=0.0007). The Chinese medicinal herbs were better than Western medicine in reducing the adverse reactions (RR: 0.30; 95% CI: 0.15 to 0.62;p=0.001). And all these funnel plots showed unlikelihood of publishing bias.Conclusions. The results indicate that Chinese medicinal herbs may have greater overall efficacy with fewer adverse drug reactions, although the evidence is weak owing to the low methodological quality and the small number of the included trials.

Sign in / Sign up

Export Citation Format

Share Document