International journal of surgery
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Review Meta Analysis Comparative Study
Intravenous versus topical tranexamic acid in primary total hip replacement: A systemic review and meta-analysis.
Total hip arthroplasty (THA) is associated with substantial blood loss. Tranexamic acid (TXA) could reduce perioperative blood loss. The optimal administration routine of TXA remains controversial. The objective of the present systemic review and meta-analysis was to compare the effectiveness and safety of various application methods of tranexamic acid in primary THA. ⋯ The topical administration of TXA in THA carried similar hemostasis effects compared with intravenous use without an increased risk of thrombotic complications. No other adverse effect was identified. Topical TXA application was a simple, safe, effective and cost-effective adjunct for blood management following primary THA. For patients with a high risk of thromboembolic events, there may be benefits with topical administration.
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Review Meta Analysis
Topical fibrin sealant versus intravenous tranexamic acid for reducing blood loss following total knee arthroplasty: A systematic review and meta-analysis.
Efficacy and safety of topical application of a fibrin sealant (FS) compared with intravenous administration of tranexamic acid (TXA) for reducing blood loss after total knee arthroplasty (TKA) is controversial. We undertook a meta-analysis to compare the effects of topical application of FS or intravenous administration of TXA on blood loss after TKA. ⋯ Our meta-analysis suggests that intravenous administration of TXA for patients undergoing TKA may reduce blood-transfusion requirements and maintain higher hemoglobin levels compared with topical application of FS in the early postoperative period. There were no significant differences in total calculated blood loss and prevalence of complications between the two groups. However, owing to the variation of included studies, no firm conclusions can be drawn.
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While the analgesic benefits of systemically administered non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain are well established, benefits of locally administered NSAIDs remain unclear outside the field of ophthalmologic surgery. Studies of local NSAID administration for postoperative analgesia vary considerably in terms of dosing and methodologic quality, making it difficult to derive clinically useful information. The primary objective of this systematic review is to summarize the currently available literature in order to assess the value of local NSAIDs as a component of the multimodal postoperative pain management regimen. ⋯ CRD42016038464.
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Retroperitoneal sarcomas are a rare group of malignant soft tissue tumors with a generally poor prognosis. The aim of the study was to define the demographic characteristics and prognostic factors for patients with retroperitoneal sarcomas (RPS) in a Tertiary Referral Center at Mexico. ⋯ In this study of patients with retroperitoneal, complete resection and liposarcoma histology are prognostic factors related to the disease-free and overall survival. Patients approached with curative intent should undergo aggressive attempts at complete surgical resection.
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Review Meta Analysis
Adductor canal block versus continuous femoral nerve block in primary total knee arthroplasty: A meta-analysis.
Continuous femoral nerve block (CFNB) is considered the preferred analgesia after TKA. However, it may weaken quadriceps muscle strength, subsequently increasing the risk of falling. Adductor canal block (ACB) is a new sensory block technique that effectively relieves postoperative pain while preserving quadriceps strength. Thias meta-analysis was conducted to determine whether ACB of CFNB provides better pain relief and functional recovery after TKA. ⋯ Compared with CFNB, ACB provides equally effective analgesia after TKA. ACB results in fast pain relief and early ambulation while decreasing post-operative nausea. ACB thus has the potential to replace CFNB as the gold standard for pain management in TKA patients.