Faculty Opinions recommendation of Will the Real Benefits of Single-Shot Interscalene Block Please Stand Up? A Systematic Review and Meta-Analysis.

AbstractBackground and aimsSingle-shot spinal with bupivacaine plus fentanyl or sufentanil is commonly used as analgesia during labour, but the short duration limits the clinical feasibility. Different drugs have been added to prolong the analgesic duration. The additional effect of intra-thecal morphine has been studied during labour pain as well as after surgery. We assessed whether adding morphine to intra-thecal bupivacaine + fentanyl or sufentanil prolongs pain relief during labour.MethodsMeta-analysis of placebo-controlled randomized clinical trials of analgesia prolongation after single-shot intrathecal morphine ≤250µg during labour when given in combination with bupivacaine + fentanyl or sufentanil. After identifying 461 references, 24 eligible studies were evaluated after excluding duplicate publications, case reports, studies of analgesia after caesarean delivery, and epidural labour analgesia. Mean duration in minutes was the primary outcome measure and was included in the calculation of the standardized mean difference. Duration was defined as the time between a single shot spinal until patient request of rescue analgesia. All reported side effects were registered. Results of individual trials were combined using a random effect model. Cochrane tool was used to assess risk of bias.ResultsFive randomized placebo-controlled clinical trials (286 patients) were included in the metaanalysis. A dose of 50–250µg intrathecal morphine prolonged labour analgesia by a mean of 60.6 min (range 3–155 min). Adding morphine demonstrated a medium beneficial effect as we found a pooled effect of standardized mean difference = 0.57 (95% CI: –0.10 to 1.24) with high heterogeneity (I2 =88.1%). However, the beneficial effect was statistically non-significant (z =1.66, p = 0.096). The lower-bias trials showed a small statistically non-significant beneficial effect with lower heterogeneity. In influential analysis, that excluded one study at a time from the meta-analysis, the effect size appears unstable and the results indicate no robustness of effect. Omitting the study with highest effects size reduces the pooled effect markedly and that study suffers from inadequate concealment of treatment allocation and blinding. Trial quality was generally low, and there were too few trials to explore sources of heterogeneity in meta-regression and stratified analyses. In general, performing meta-analyses on a small number of trials are possible and may be helpful if one is aware of the limitations. As few as one more placebo-controlled trial would increase the reliability greatly.ConclusionsEvidence from this systematic review suggests a possible beneficial prolonging effect of adding morphine to spinal analgesia with bupivacaine + fentanyl or +sufentanil during labour. The study quality was low and heterogeneity high. No severe side effects were reported. More adequately-powered randomized trials with low bias are needed to determine the benefits and harms of adding morphine to spinal local anaesthetic analgesia during labour.ImplicationsEpidural analgesia is documented as the most effective method for providing pain relief during labour, but from a global perspective most women in labour have no access to epidural analgesia. Adding morphine to single shot spinal injection of low dose bupivacaine, fentanyl or sufentanil may be efficacious but needs to be investigated.

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Analgesic Impact of Single-Shot Versus Continuous Femoral Nerve Block After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Advances in Therapy ◽

10.1007/s12325-019-01194-z ◽

2020 ◽

Vol 37 (2) ◽

pp. 671-685 ◽

Cited By ~ 1

Author(s):

Shiyi Li ◽

Jinpeng Zhou ◽

Xiuyan Li ◽

Xiufei Teng ◽

Yang Li ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Nerve Block ◽

Knee Arthroplasty ◽

Femoral Nerve Block ◽

Meta Analysis ◽

Femoral Nerve ◽

Single Shot ◽

Continuous Femoral Nerve Block ◽

Total Knee

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Predicting adult weight change in the real world: a systematic review and meta-analysis accounting for compensatory changes in energy intake or expenditure

International Journal of Obesity ◽

10.1038/ijo.2014.184 ◽

2014 ◽

Vol 39 (8) ◽

pp. 1181-1187 ◽

Cited By ~ 36

Author(s):

E J Dhurandhar ◽

K A Kaiser ◽

J A Dawson ◽

A S Alcorn ◽

K D Keating ◽

...

Keyword(s):

Systematic Review ◽

Energy Intake ◽

Real World ◽

Weight Change ◽

Meta Analysis ◽

Adult Weight ◽

The Real

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Direct comparison of non-vitamin K antagonist oral anticoagulant versus warfarin for stroke prevention in non-valvular atrial fibrillation: a systematic review and meta-analysis of real-world evidences

The Egyptian Heart Journal ◽

10.1186/s43044-021-00194-1 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Yoga Waranugraha ◽

Ardian Rizal ◽

Mokhamad Fahmi Rizki Syaban ◽

Icha Farihah Deniyati Faratisha ◽

Nabila Erina Erwan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Vitamin K ◽

Real World ◽

Stroke Risk ◽

Meta Analysis ◽

Bleeding Risk ◽

Vitamin K Antagonist ◽

The Real ◽

All Cause Mortality

Abstract Background To overcome the several drawbacks of warfarin, non-vitamin K antagonist oral anticoagulants (NOACs) were developed. Even though randomized controlled trials (RCTs) provided high-quality evidence, the real-world evidence is still needed. This systematic review and meta-analysis proposed to measure the safety and efficacy profile between warfarin and NOACs in non-valvular atrial fibrillation (NVAF) patients in preventing stroke. Results We collected articles about the real-world studies comparing warfarin and NOACs for NVAF patients recorded in electronic scientific databases such as Embase, ProQuest, PubMed, and Cochrane. The pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the generic inverse variance method. A total of 34 real-world studies, including 2287288 NVAF patients, were involved in this study. NOACs effectively reduced the stroke risk than warfarin (HR 0.77; 95% CI 0.69 to 0.87; p < 0.01). Moreover, NOACs effectively lowered all-cause mortality risk (HR 0.71; 95% CI 0.63 to 0.81; p < 0.01). From the safety aspect, compared to warfarin, NOACs significantly reduced major bleeding risk (HR 0.68; 95% CI 0.54 to 0.86; p < 0.01) and intracranial bleeding risk (HR 0.54; 95% CI 0.42 to 0.70; p < 0.01). However, NOACs administration failed to decrease gastrointestinal bleeding risk (HR 0.78; 95% CI 0.58 to 1.06; p = 0.12). Conclusions In NVAF patients, NOACs were found to be more effective than warfarin at reducing stroke risk. NOACSs also lowered the risk of all-cause mortality, cerebral hemorrhage, and severe bleeding in NVAF patients compared to warfarin.

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179 Effect of interscalene block versus anterior suprascapular nerve block on intraoperative and pacu analgesia requirements: a systematic review and meta-analysis

10.1136/rapm-2021-esra.179 ◽

2021 ◽

Author(s):

K Davis ◽

D Reardon ◽

G Velli ◽

M Bright ◽

L White

Keyword(s):

Systematic Review ◽

Nerve Block ◽

Meta Analysis ◽

Suprascapular Nerve ◽

Interscalene Block ◽

Suprascapular Nerve Block

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Do Evidence-Based Interventions Work When Tested in the “Real World?” A Systematic Review and Meta-analysis of Parent Management Training for the Treatment of Child Disruptive Behavior

Clinical Child and Family Psychology Review ◽

10.1007/s10567-013-0128-0 ◽

2013 ◽

Vol 16 (1) ◽

pp. 18-34 ◽

Cited By ~ 123

Author(s):

Daniel Michelson ◽

Clare Davenport ◽

Janine Dretzke ◽

Jane Barlow ◽

Crispin Day

Keyword(s):

Systematic Review ◽

Disruptive Behavior ◽

Real World ◽

Meta Analysis ◽

Management Training ◽

Parent Management Training ◽

Evidence Based ◽

The Real ◽

Child Disruptive Behavior ◽

Parent Management

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Real-World Effectiveness and Safety of Tofacitinib in Patients With Ulcerative Colitis: Systematic Review With Meta-Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izab011 ◽

2021 ◽

Author(s):

Carlos Taxonera ◽

David Olivares ◽

Cristina Alba

Keyword(s):

Systematic Review ◽

Ulcerative Colitis ◽

Clinical Trials ◽

Real World ◽

Meta Analysis ◽

Mucosal Healing ◽

Incidence Rates ◽

Serious Adverse Events ◽

The Real ◽

Rate Of Response

Abstract Background Knowledge of the real-world effectiveness and safety of tofacitinib for ulcerative colitis (UC) is relevant to confirm the benefit observed in clinical trials. Methods This systematic review and meta-analysis evaluated the real-world effectiveness of tofacitinib for moderate to severely active UC. The primary outcome was clinical remission evaluated at week 8, weeks 12 to 16, and month 6. Secondary outcomes were response, corticosteroid-free remission, mucosal healing, colectomy, and safety. Results Seventeen studies with a total of 1162 patients with UC were included. Remission (11 studies) was achieved in 34.7% of patients at week 8 (95% confidence interval [CI], 24.4%-45.1%), 47% at weeks 12 to 16 (95% CI, 40.3%-53.6%), and 38.3% at month 6 (95% CI, 29.2%-47.5%) at month 6 duplicated. Response was achieved in 62.1%, 64.2%, 50.8%, and 41.8% of patients at week 8, weeks 12 to 16, month 6, and month 12, respectively. Corticosteroid-free remission (5 studies) was achieved in 38.4%, 44.3%, 33.6%, and 31% of patients at week 8, weeks 12 to 16, month 6, and month 12, respectively. Mucosal healing was achieved in 48.3% and 45.3% of patients at week 8 and weeks 12 to 16, respectively. Patients who were biologic-naïve (11.6%) had a significantly higher rate of response at week 8 (1.38; 95% CI, 1.03-1.84). The incidence rates of serious adverse events and herpes zoster was 8.9 and 6.9 per 100 patient-years, respectively. Conclusions This meta-analysis of real-world studies confirms the effectiveness of tofacitinib in a highly refractory population of patients with moderate to severely active UC. Tofacitinib showed an acceptable safety profile. These findings were consistent with clinical trials and further support the use of tofacitinib in UC.

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