Faculty Opinions recommendation of Continuous peripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials.

2012 ◽  
Author(s):  
Jan Jakobsson
Keyword(s):  
Systematic Review ◽  
Peripheral Nerve ◽  
Randomized Controlled Trials ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Single Injection ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Continuous Peripheral Nerve Block

scholarly journals The effectiveness of Bupivacaine as a pre-emptivepudendal block among patients undergoing vaginal surgeries: meta-analysis of randomized controlled trials

2019 ◽  
Author(s):  
Munazzah Rafique ◽  
Jacqueline Y Thompson ◽  
Dania Al-Jaroudi ◽  
Ahmed Al-Badr
Keyword(s):  
Systematic Review ◽  
Pelvic Floor ◽  
Randomized Controlled Trials ◽  
Nerve Block ◽  
Pudendal Nerve ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Pudendal Nerve Block ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background: Pre-emptive analgesia using pudendal nerve block (PNB) with bupivacaine is commonly used in clinical practice during pelvic floor and vaginal surgeries. However, its effectiveness is unclear. To update the evidence base we summarised short- and intermediate-term outcomes of pre-emptive analgesia using pudendal nerve block with bupivacaine as an approach in the management of pelvic floor and vaginal surgeries. Methods: We searched the CENTRAL, PubMed, ClinicalTrials.gov, google scholar and Open Grey from inception until April 2019. The citation lists of relevant papers were also searched. Randomized controlled trials (RCTs) of women who underwent perineal, pelvic floor or vaginal surgeries and received pre-emptive analgesia using a pudendal nerve block were included. Two authors independently screened and selected eligible trials as well as performed data extraction and quality assessment. Disagreements were resolved via consensus and an adjudicator was involved when consensus was not achieved. Data was narratively synthesized, when possible, data was pooled in RevMan 5 using random effects model. Results: Four RCTs with a total of 349 participants were eligible for inclusion. We found evidence of small effect for improvement in post-operative pain scores; requirements for opioids, SMD: -0.89 (95% CI: -1.19, -0.59) and non-steroidal anti-inflammatories SMD -1.04 (95% CI: -1.64, -0.43) in favour of the PNB versus control group. The risk ratio for adverse effects 0.42 (95% CI: 0.18, 0.99) favoured PNB. There was no significant difference between groups for length of hospital stay, MD: -0.82 (95% CI: -5.34, 3.69) and return to normal activity. Conclusion:We found inconclusive evidence that pre-emptive pudendal block using bupivacaine may improve postoperative pain and recovery in perineal, pelvic floor or vaginal surgeries. However, due to the scant and poor quality of evidence included in this systematic review, well-designed and adequately powered RCTs that adhere to reporting guidelines and evaluate key outcomes are needed to inform clinical guidelines on the use of pre-emptive pudendal block. Key words:pre-emptive analgesia, bupivacaine, pudendal nerve block, vaginal surgery, pelvic organ prolapse, systematic review, meta-analysis

Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

2018 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Middle Income ◽  
Brief Motivational Intervention ◽  
Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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