scholarly journals Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

2020 ◽  
Author(s):  
Yamini Subramani ◽  
Mahesh Nagappa ◽  
Kamal Kumar ◽  
Lee-Anne Fochesato ◽  
Moaz Bin Yunus Chohan ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lower Incidence ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Fentanyl Group

Abstract Background Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia. It may be bothersome and can also interfere with perioperative monitoring. The intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering in several studies in literature. Objective We performed this meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified oxford scoring system. Dichotomous data were extracted and summarized using Odds Ratio (OR) with 95% Credible intervals (CrI) using random-effects modeling. Statistical analysis was conducted using R studio version 1.0.153 - Inc. Results Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met inclusion criteria for intrathecal lipophilic opioids to prevent the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (Pooled Odds Ratio (OR): 0.13; 95% Credible Interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort (RR: 0.19; 95% CI: 0.10–0.35; P < 0.00001), The IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18–32.46; P = 0.03) The IT Meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09–0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14–5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. Conclusion IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine also decreased the incidence and severity of shivering, but it was associated with significant nausea and vomiting.

scholarly journals Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

2020 ◽  
Author(s):  
Yamini Subramani ◽  
Mahesh Nagappa ◽  
Kamal Kumar ◽  
Lee-Anne Fochesato ◽  
Moaz Bin Yunus Chohan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Fentanyl Group

Abstract Background: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering.Objective: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc. Results: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result. Conclusion: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

scholarly journals Effect of Intrathecal Lipophilic Opioids on the Incidence of Shivering in Women Undergoing Cesarean Delivery after Spinal Anesthesia: A Systematic Review and Bayesian Network Meta- analysis of Randomized Controlled Trials.

2020 ◽  
Author(s):  
Yamini Subramani ◽  
Mahesh Nagappa ◽  
Kamal Kumar ◽  
Lee-Anne Fochesato ◽  
Moaz Bin Yunus Chohan ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Credible Interval ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Fentanyl Group

Abstract Background: Shivering is a common side effect in women having cesarean delivery (CD) under spinal anesthesia, which can be bothersome to the patient, and it can also interfere with perioperative monitoring. In several studies, the intrathecal (IT) addition of a lipophilic opioid to local anesthetics has been shown to decrease the incidence of shivering. Objective: We performed this network meta-analysis to evaluate the effects of intrathecal lipophilic opioids in preventing the incidence of shivering in patients undergoing CD. Methods: This review was planned according to the PRISMA for Network Meta-Analysis (PRISMA-NMA) guidelines. An English literature search of multiple electronic databases was conducted. We included randomized controlled trials (RCTs) that reported on the incidence of shivering, with study groups receiving either IT fentanyl, sufentanil, or meperidine in women undergoing CD under spinal anesthesia. Quality of the studies was assessed using the modified Oxford scoring system. Using random-effects modeling, dichotomous data were extracted and summarized using odds ratio (OR) with a 95% credible interval (CrI). Statistical analysis was conducted using R studio version 1.0.153 - Inc.Results: Twenty-one studies consisting of 1433 patients (Control group: 590 patients in twenty-one studies; Fentanyl group:199 patients in seven studies; Sufentanil group: 156 patients in five studies; Meperidine group: 488 patients in ten studies) met the inclusion criteria for this systematic review investigating the effect of intrathecal lipophilic opioids in preventing the incidence of shivering in women undergoing cesarean delivery under spinal anesthesia. Methodological validity scores ranged from 3 to 7. The Bayesian mixed network estimate showed the incidence of shivering was significantly lower with IT fentanyl (pooled odds ratio (OR): 0.13; 95% credible interval (CrI): 0.04 to 0.35; P = 0.0004) and IT meperidine (OR: 0.12; 95% CrI: 0.05 to 0.29; P < 0.00001), but not with IT sufentanil (OR: 0.37; 95% CrI: 0.11 to 1.22; P = 0.23). The IT fentanyl group had a significantly lower incidence of intraoperative discomfort [Risk Ratio (RR): 0.19; 95% CI: 0.10-0.35; P < 0.00001], the IT sufentanil group had a significantly higher incidence of pruritus (RR: 6.18; 95% CI: 1.18-32.46; P = 0.03) The IT meperidine group had a significantly lower incidence of intraoperative discomfort (2.7% vs. 13.6%; RR: 0.22; 95% CI: 0.09-0.55; P = 0.001), but there was a significant increase in nausea and vomiting (IT meperidine group vs. Control group: 42.7% vs. 19.4%; RR: 2.56; 95% CI: 1.14-5.75; P = 0.02). Meta-regression analysis based on the opioid dose and quality of the study did not impact the final inference of our result.Conclusion: IT fentanyl significantly decreased the incidence of shivering in women undergoing CD under spinal anesthesia without increasing maternal adverse events, confirming that routine use in this patient population is a good choice. IT sufentanil did not decrease the incidence of shivering. IT meperidine decreased the incidence and severity of shivering, but its use was also associated with significant nausea and vomiting.

scholarly journals The Effectiveness of Moxibustion: An Overview During 10 Years

2011 ◽  
Vol 2011 ◽  
pp. 1-19 ◽  
Author(s):  
Song-Yi Kim ◽  
Younbyoung Chae ◽  
Seung Min Lee ◽  
Hyejung Lee ◽  
Hi-Joon Park
Keyword(s):  
Meta Analysis ◽  
Breech Presentation ◽  
Control Group ◽  
Controlled Trials ◽  
Control Groups ◽  
Randomized Controlled ◽  
Language Restriction ◽  
Digestive Disorders ◽  
General Care

Moxibustion has been used to treat various types of disease. However, there is still insufficient evidence regarding its effectiveness. This study was performed to summarize and evaluate the effectiveness of moxibustion. A search was performed for all randomized controlled trials in PubMed between January 1998 and July 2008 with no language restriction. The results yielded 47 trials in which six moxibustion types were applied to 36 diseases ranging from breech presentation to digestive disorders. Moxibustion was compared to three types of control group: general care, Oriental medical therapies or waiting list. Moxibustion was superior to the control in 14 out of 54 control groups in 46 studies. There were no significant differences among groups in 7 studies, and the outcome direction was not determined in 33 studies. Seven studies were included in a meta-analysis. Moxibustion was more effective than medication in two ulcerative colitis studies (relative risk (95% CI), 2.20 (1.37, 3.52),P= .001,I2= 0%). Overall, our results did not support the effectiveness of moxibustion in specific diseases due to the limited number and low quality of the studies and inadequate use of controls. In order to provide appropriate evidence regarding the effectiveness of moxibustion, more rigorous clinical trials using appropriate controls are warranted.

scholarly journals Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 9 (2) ◽  
pp. 493 ◽  
Author(s):  
Chang-Hoon Koo ◽  
Hyun-Jung Shin ◽  
Sung-Hee Han ◽  
Jung-Hee Ryu
Keyword(s):  
Randomized Controlled Trials ◽  
Spinal Anesthesia ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Control Groups ◽  
Lidocaine Group ◽  
Randomized Controlled ◽  
Meta Analyses

The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p < 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p < 0.001) or isobaric lidocaine (p < 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.

Intravenous dexmedetomidine versus intravenous clonidine for post spinal anesthesia shivering: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 65 (3) ◽  
pp. 94-102
Author(s):  
Na Wang ◽  
Zaitang Wang ◽  
Xuesong Song ◽  
Jinguo Wang
Keyword(s):  
Randomized Controlled Trials ◽  
Spinal Anesthesia ◽  
Odds Ratio ◽  
Treatment Time ◽  
Meta Analysis ◽  
Effective Rate ◽  
Controlled Trials ◽  
Adrenergic Agonists ◽  
Randomized Controlled ◽  
Mean Differences

Background Dexmedetomidine and clonidine are the most extensively studied drugs for shivering treatment, because α2-adrenergic agonists can reduce the shivering threshold. The objective of this meta-analysis was to compare the efficacy and complications of dexmedetomidine with those of clonidine, when used for control of post spinal anesthesia shivering. Methods Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of dexmedetomidine versus clonidine for control of post spinal anesthesia shivering. The endpoints were effective rate of shivering treatment, time to cease shivering, recurrent rate of shivering and complications. Results Six studies comprising 340 adult patients were included in this meta-analysis. Dexmedetomidine had higher effective rate of shivering treatment (odds ratio [OR]: 4.11, 95% confidence interval (CI): [1.53, 11.07], P = 0.005), shorter time to cease shivering (Mean differences (MD)=–1.91; 95% CI [–3.66, –0.15], P = 0.03), lower recurrent rate of shivering (OR = 0.30; 95% CI [0.12, 0.75], P = 0.01), compared to clonidine. Dexmedetomidine had a lower rate of hypotension and higher incidence of sedation than clonidine. Conclusions Dexmedetomidine is superior to clonidine when used for shivering treatment after spinal anesthesia, because of higher incidence of effective rate and sedation, faster control of shivering, lower incidence of recurrent rate and hypotention.

scholarly journals Mycophenolate Mofetil in the Treatment of Steroid-Dependent or Frequently Relapsing Nephrotic Syndrome in Children: A Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Xin Xiang ◽  
Shi-Yuan Qiu ◽  
Mo Wang
Keyword(s):  
Nephrotic Syndrome ◽  
Mycophenolate Mofetil ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Frequently Relapsing Nephrotic Syndrome ◽  
Randomized Controlled ◽  
Steroid Dependent

Objectives: This meta-analysis aims to evaluate the efficacy and safety of the mycophenolate mofetil (MMF) in the treatment of steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS) in children.Methods: We searched for the studies especially the randomized controlled trials in PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wan Fang database. The data were analyzed by Review Manager 5.3 software. We used the GRADE pro-Guideline Development Tool online software to evaluate the quality of evidence.Results: Finally, we identified 620 studies, of which we included five randomized controlled trials and one prospective cohort study with 447 children. The results showed the following: (1) the relapse-free survival rate within 1 year—the MMF group was superior to the levamisole group [ratio difference (RD) = 0.13, 95% CI (0.02, 0.24), P = 0.02] but not to the calcineurin inhibitors (CNIs) group [RD = −0.27, 95%CI (−0.40, −0.14), P &lt; 0.0001]; (2) the number of relapses within 1 year—the MMF group was less than that in the CNIs and levamisole group [mean difference (MD) = −0.26, 95%CI (−0.45, −0.08), P = 0.005]; (3) the cumulative prednisone dosage—the MMF group was lower than that in the control group [standardized mean difference (SMD) = −0.32, 95%CI (−0.53, −0.11), P = 0.003]; (4) incidence of adverse reactions—there was no significant difference between the MMF group and the control group [RD = 0.02, 95%CI (−0.04, 0.09), P = 0.46].Conclusion: The therapy of mycophenolate mofetil in the treatment of SDNS or FRNS in children has a certain advantage in reducing the number of relapses and cumulative prednisone dosage within 1 year when compared with the CNIs and levamisole. However, due to the limited quantity and quality of the included studies, the conclusions above need to be confirmed by more high-quality randomized controlled trials.

scholarly journals Clinical Effects of Baduanjin Qigong Exercise on Cancer Patients: A Systematic Review and Meta-Analysis on Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Chi-Chun Kuo ◽  
Chiao-Chen Wang ◽  
Wei-Lun Chang ◽  
Tzu-Ching Liao ◽  
Pei-En Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Sleep Quality ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Clinical Effects ◽  
Randomized Controlled

Objective. Baduanjin is a traditional Chinese Qigong exercise for health improvement. However, a few studies were examining the association between Baduanjin Qigong exercise and cancer patients. This study is conducted to explore the clinical effects of the Baduanjin Qigong exercise among cancer patients. Methods. We conducted a systematic review and meta-analysis using randomized controlled trials to assess the effects of the Baduanjin Qigong exercise on cancer patients. We searched Cochrane Library, PubMed, Embase, and Airiti Library for all relevant studies from inception through December 31, 2020, without language limitations. Two authors independently screened selected studies, assessed the quality of included studies, and extracted information. Any disagreement was discussed with a third senior author. Summary estimates were obtained using meta-analysis with the random effects model. Results. Among the fourteen articles involved in the systematic review, ten studies were included in the meta-analysis. Cancer patients with moderate-severe cancer-related fatigue were significantly less in the Baduanjin group compared with the control group (odds ratio = 0.27; 95% confidence interval (CI) [0.17, 0.42]). Three studies used the questionnaire of Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) in the assessment of quality of life, and two used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). For FACT-B, the Baduanjin group scored significantly higher than the control group (mean difference = 11.04, 95% CI [9.56, 12.53]). For EORTC QLQ-C30, the Baduanjin group scored significantly higher than the control group (mean difference = 10.57, 95% CI [7.82, 13.32]). The Pittsburgh Sleep Quality Index (PSQI) score for sleep quality of the Baduanjin group is significantly lower than the control group (mean difference = −2.89, 95% CI [−3.48, −2.30]). Conclusion. In conclusion, we found the Baduanjin exercise had positive clinical effects on cancer patients. This meta-analysis not only supported that the Baduanjin exercise can alleviate the degree of cancer-related fatigue in patients but also improved their quality of life and sleep quality. Further long-term follow-up randomized controlled trials are warranted.

scholarly journals Effects of four types of integrated Chinese and Western medicines for the treatment of COVID-19 in China: a network meta-analysis

2020 ◽  
Vol 66 (6) ◽  
pp. 771-777
Author(s):  
Lairun Jin ◽  
Yan Xu ◽  
Hui Yuan
Keyword(s):  
Computed Tomography ◽  
Supportive Care ◽  
Western Medicine ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Observation Group ◽  
Randomized Controlled ◽  
Different Types

SUMMARY OBJECTIVE Various integrated Chinese and Western medicines might be beneficial for the treatment of Coronavirus disease 2019 (COVID-19). This study aims to evaluate the efficacy of lung computed tomography (CT) of four integrated Chinese and Western medicines in the treatment of COVID-19 using network meta-analysis (NMA). METHODS Multiple databases were consulted to find randomized controlled trials of four different types of integrated Chinese and Western medicines for the treatment of COVID-19. NMA was conducted on the data using Stata (13.0) software. The odds ratio (OR) was calculated. The studies included in this paper were divided into a control group (Western medicine) and an observation group (one of four integrated Chinese and Western medicines). RESULTS 5 eligible publications were identified. A total of 598 cases were included in the study, and the results showed that the four types of integrated Chinese and Western medicines (symptomatic and supportive care with Qingfei Touxie Fuzheng, Lianhua Qingke, and Xuebijing) were significantly superior (P < 0.05) to symptomatic and supportive care alone, except for symptomatic and supportive care with Lianhua Qingwen. The combination of symptomatic and supportive care with Lianhua Qingke had the highest probability of being the most clinically efficacious intervention, with a surface under the cumulative ranking (SUCRA) curve of 85.7. CONCLUSIONS A combination of symptomatic and supportive care with Lianhua Qingke is the best option among the four integrated Chinese and Western medicines considered for the treatment of COVID-19.

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