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 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 The clinical efficacy of continuous renal replacement in the treatment of acute pancreatitis: a meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
sijia Ma ◽  
mingming Zhao ◽  
zhiyu Pan ◽  
jiao Fan ◽  
xuexue Zhang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Randomized Controlled Trials ◽  
Clinical Efficacy ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Review Author ◽  
Inclusion Criteria ◽  
Randomized Controlled

Abstract：Objective: The purpose of this study was to investigate the effect of continuous renal replacement therapy(CRRT) on patients with acute pancreatitis(AP). Methods: A comprehensive search of seven databases without language restrictions includes PubMed, Cochrane Library, Scopus, Embase, Web of Science, China National Knowledge Infrastructure(CNKI) and Wan fang database. Randomized controlled trials (RCTs) for the treatment of acute pancreatitis with CRRT were searched. All the included literatures were published before December 2020. Two review authors independently selected the study and extracted the data according to the inclusion criteria. A third review author will and discuss with the first two review authors and resolve the differences. Weighted mean difference(WMD), risk ratio (RR), and 95% confidence interval (CI) were used for estimating the clinical efficacy of AP in CRRT and control treatment. Results: Fifty-three RCTs met the inclusion criteria and were used in the meta-analysis, with a total of 3,382 effective samples. A comprehensive review of the system shows that the mortality rate of the CRRT group was significantly lower than that of the control group, and the difference was statistically significant(RR=0.44,95%CI0.34 to 0.57,P< 0.000001), the patients using CRRT had lower APACHE Ⅱ scores level(WMD=-3.78, 95%CI-4.66 to -2.90,P<0.00001),higher CRP, PCT,TNF-αand IL-6 clearance effect. According to liver function, the patients using CRRT had lower ALT and AST levels. In the same way, according to renal function, the patients using CRRT had lower SCr (WMD=-94.28, 95%CI-125.47 to -63.10, P<0.00001). The patients using CRRT also had higher ALB levels(WMD=2.32, 95%CI-1.05 to 3.59 ,P=0.0003). Moreover, Results shown no statistical difference in Serum potassium level (WMD=-0.00, 95%CI-0.31 to 0.31,P=1.00)between the two groups. Conclusions: Our findings suggest that treatment with CRRT for acute pancreatitis may be more beneficial than conventional treatment. However, high-quality studies with a larger sample size are still needed to confirm our results.

scholarly journals The Efficacy of Preoperative Gabapentin in Spinal Surgery: A Meta-Analysis of Randomized Controlled Trials

2017 ◽  
Vol 7 (20;7) ◽  
pp. 649-661
Author(s):  
Xin-long Ma
Keyword(s):  
Adverse Effects ◽  
Randomized Controlled Trials ◽  
Incidence Rate ◽  
Spinal Surgery ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Analog Scale ◽  
Randomized Controlled ◽  
Vas Scores

Background: Pain management after spinal surgery has been studied for years. Gabapentin is a third-generation antiepileptic drug that selectively affects the nociceptive process and has been used for pain relief after surgery. However, the relationship between gabapentin and postoperative pain in spinal surgery is still controversial. Objective: To assess the efficacy of the pre-emptive use of gabapentin in spinal surgery. Study Design: A meta-analysis of randomized controlled studies. Setting: The MEDLINE, EMBASE, ClinicalTrials.gov, and Web of Science databases were systematically searched. Methods: This meta-analysis of randomized controlled trials (RCTs) was performed to compare the use of gabapentin with placebo in spinal surgery regarding to the following: the mean difference (MD) of postoperative opioid requirements, the changes of visual analog scale (VAS) scores in 2 groups, and the incidence rate of adverse effects. An electronic-based search of all related literatures was conducted, and only RCTs for spinal surgery were included. The MD of postoperative opioid requirements and VAS scores and the relative risk (RR) of the incidence rate of adverse effects in the gabapentin group versus the placebo group were extracted throughout the study. Results: Ten trials, involving 827 patients, met the inclusion criteria and were included in this meta-analysis. The total morphine consumption was significantly lower over the first 24 hours postoperatively in the gabapentin group (P < 0.05). The VAS scores at 2, 4, 6, 12, and 24 hours were less in the gabapentin group (P < 0.05). The incidence rate of vomiting, pruritus, and urinary retention was significantly less in the gabapentin groups (RR = 0.53, 95% CI 0.32–0.86, P < 0.05; RR = 0.38, 95% CI 0.22–0.66, P < 0.05; RR = 0.57, 95% CI 0.34–0.98, P < 0.05, respectively). Limitations: All of the studies we screened were published online except for unpublished articles. Only 10 RCTs met our inclusion criteria, so the sample size was still relatively small. Conclusion: This meta-analysis suggests that the administration of gabapentin is effective in reducing postoperative opioid consumption, VAS scores, and some side effects after spinal surgery. Key words: Gabapentin, analgesia, spinal surgery, meta-analysis, randomized controlled trials, visual analog scale score, side effect

scholarly journals Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Nijuan Li ◽  
Li Hu ◽  
Chunping Li ◽  
Xuelin Pan ◽  
Yong Tang
Keyword(s):  
Sensitivity Analysis ◽  
Randomized Controlled Trials ◽  
Local Anesthetics ◽  
Analgesic Effect ◽  
Meta Analysis ◽  
Labor Analgesia ◽  
Labor Pain ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Background. This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor. Methods. Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data. Results. Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min ( P = 0.002 ), 30 min ( P = 0.01 ), and 120 min ( P = 0.02 ) after block and at the moment of fetal disengagement ( P = 0.0002 ), decreased mean arterial pressure of 120 min ( P = 0.01 ), heart rate of 30 min ( P = 0.003 ), 60 min ( P < 0.00001 ), and 120 min ( P < 0.00001 ) after block, blood loss ( P = 0.02 ), and the incidence of nausea/vomiting ( P = 0.006 ), and increased the incidence of maternal bradycardia ( P = 0.04 ). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block ( P < 0.00001 ) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting ( P = 0.002 ), increased the incidence of maternal bradycardia ( P = 0.04 ), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different. Conclusions. Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.

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