scholarly journals Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Pain after Craniotomy: A Narrative Review

2021 ◽  
Vol 11 (12) ◽  
pp. 1636
Author(s):  
Nesjla Sofia Syrous ◽  
Terje Sundstrøm ◽  
Eirik Søfteland ◽  
Ib Jammer
Keyword(s):  
Postoperative Pain ◽  
Meta Analysis ◽  
Narrative Review ◽  
Controlled Trials ◽  
Free Text ◽  
Medical Subject Headings ◽  
Randomized Controlled ◽  
Haemodynamic Stability ◽  
Randomised Controlled ◽  
Dexmedetomidine Infusion

Craniotomy involves procedures with high incidences of postoperative pain. Dexmedetomidine, a highly selective a2-adrenoreceptor agonist, has been shown to be beneficial in neuroanaesthesia. The purpose of this narrative review was to assess the effect and safety of dexmedetomidine given intraoperatively during anaesthesia compared to placebo and demonstrate the effect on acute postoperative pain in adult patients undergoing craniotomy. Literature published from 1996 until 2021 were analysed through a search of PubMed, Medline and Embase. Randomised controlled trials investigating intraoperative administration of Dexmedetomidine with evaluation of postoperative pain were included. Medical Subject Headings terms and free-text words were used to identify articles related to the intraoperative use of Dexmedetomidine and postcraniotomy pain. Thirteen distinct randomized controlled trials with 882 recruited patients undergoing craniotomy were identified as eligible for final inclusion. Intraoperative administration of dexmedetomidine is associated with decreased postoperative pain and opioid consumption, and it assures haemodynamic stability. Dexmedetomidine is an efficacious adjunct in craniotomy in adults, showing benefits in reduction of postoperative pain and analgesic consumption. Dexmedetomidine also offers haemodynamic stability. However, widespread methodological heterogeneity of the papers prohibits a valid meta-analysis.

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

2020 ◽  
Vol 24 (7) ◽  
pp. 1215-1227 ◽  
Author(s):  
Ambika Paramasivan ◽  
Maria A. Lopez‐Olivo ◽  
Theng W. Foong ◽  
Yi W. Tan ◽  
Andrea P. A. Yap
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals The Effect of Intraoperative Methadone Compared to Morphine on Postsurgical Pain: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Mark C. Kendall ◽  
Lucas J. Alves ◽  
Kristi Pence ◽  
Taif Mukhdomi ◽  
Daniel Croxford ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Analgesic Efficacy ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
Postanesthesia Care Unit ◽  
Controlled Trials ◽  
Randomized Controlled

Background and Objectives. Methadone is commonly used in chronic pain, but it is not frequently used as an intraoperative analgesic. Several randomized studies have compared intraoperative methadone to morphine regarding postsurgical analgesia, but they have generated conflicting results. The aim of this investigation was to compare the analgesic efficacy of intraoperative methadone to morphine in patients undergoing surgical procedures. Methods. We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases. Meta-analysis was performed using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals, and sample size. Methodological quality was evaluated using Cochrane Collaboration’s tool. Results. Seven randomized controlled trials evaluating 337 patients across different surgical procedures were included. The aggregated effect of intraoperative methadone on postoperative opioid consumption did not reveal a significant effect, WMD (95% CI) of −0.51 (−1.79 to 0.76), (P=0.43) IV morphine equivalents. In contrast, the effect of methadone on postoperative pain demonstrated a significant effect in the postanesthesia care unit, WMD (95% CI) of −1.11 (−1.88 to −0.33), P=0.005, and at 24 hours, WMD (95% CI) of −1.35 (−2.03 to −0.67), P<0.001. Conclusions. The use of intraoperative methadone reduces postoperative pain when compared to morphine. In addition, the beneficial effect of methadone on postoperative pain is not attributable to an increase in postsurgical opioid consumption. Our results suggest that intraoperative methadone may be a viable strategy to reduce acute pain in surgical patients.

scholarly journals Preoperative Oral Gabapentin in the Management of Postoperative Catheter-Related Bladder Discomfort in Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yu-Ting Wang ◽  
Chong Xiao ◽  
Hong Liu ◽  
Xi Fu ◽  
Yi-Feng Ren ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Controlled Trials ◽  
Assessment Development ◽  
Randomized Controlled ◽  
Short Time

Objective: To evaluate the efficacy and safety of preoperative oral gabapentin in preventing postoperative Catheter-Related Bladder Discomfort (CRBD) in surgical patients.Methods: Randomized controlled trials in which gabapentin was used for the prevention of CRBD in surgical patients with transurethral catheterization were evaluated. The primary outcome was the incidence of moderate-to-severe CRBD at 0, 1, 2, and 6 h after surgery, and secondary outcomes included the incidence of any grade CRBD, postoperative pain, and adverse events. Pooled risk ratios (RRs) and mean difference (MD), 95% confidence intervals (CIs), and P values were estimated using fixed and random effects statistical models. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the levels of certainty for key results.Results: A total of 6 randomized controlled trials involving 679 participants were included in the meta-analysis. Gabapentin significantly reduced the risk of moderate-to-severe CRBD at 0, 1, 2, and 6 h (0 h: RR = 0.19, 95% CI: 0.11 to 0.31, p &lt; 0.00001; 1 h: RR = 0.40, 95% CI: 0.25 to 0.66, p &lt; 0.001; 2 h: RR = 0.38, 95% CI: 0.26 to 0.56, p &lt; 0.00001; 6 h: RR = 0.20, 95% CI: 0.11 to 0.38, p &lt; 0.00001). The overall incidence of CRBD at 1 h showed no statistical difference between the two groups (RR = 0.55, 95% CI: 0.30 to 1.00, p = 0.05). The risk of CRBD was significantly reduced in the gabapentin group at 0, 2, and 6 h after surgery (0 h: RR = 0.59, 95% CI: 0.46 to 0.74, p &lt; 0.0001; 2 h: RR = 0.62, 95% CI: 0.51 to 0.75, p &lt; 0.00001; 6 h: RR = 0.66, 95% CI: 0.52 to 0.83, p &lt; 0.001). In addition, gabapentin was associated with low postoperative pain intensity without significant side effects.Conclusion: Preoperative oral gabapentin as an adjunct to surgery is effective in decreasing the risk and severity of CRBD over a short time after surgery, and it can decrease postoperative pain without significant side effects. Overall, the level of certainty was moderate to low.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42021228171.

scholarly journals Asthma in children treated with paracetamol versus ibuprofen: A systematic review and meta-analysis of randomised controlled trials

2019 ◽  
Author(s):  
Mohamed Sherbash ◽  
Luis Furuya-Kanamori ◽  
Joanne Daghfal Nader ◽  
Lukman Thalib
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Inverse Variance ◽  
Comprehensive Search ◽  
Asthma In Children ◽  
Heterogeneity Model ◽  
Randomised Controlled

Abstract Background: Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of asthma among children taking paracetamol compared to ibuprofen, remain unsettled. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) that compared asthma in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of asthma in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the inverse variance heterogeneity model. Results: Five RCTs with 85095 children were included in the analysis. The pooled estimate (RR 1.04; 95%CI 0.84-1.29) revealed no difference in the risk of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma, the pooled estimate remained similar (RR 1.03; 95%CI 0.64-1.67). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03; 95%CI 0.84-1.28). Conclusion: Ibuprofen and paracetamol have similar tolerance and safety profiles in terms of incidence of asthma in children.

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