Journal of clinical anesthesia
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Review Meta Analysis
Effects of remote ischemic preconditioning on prognosis in patients with lung injury: A meta-analysis.
A number of trials have shown that remote ischemic preconditioning (RIPC) could reduce lung injury of patients suffering cardiovascular surgery, pulmonary transplantation surgery and thoracic surgery with one-lung ventilation. However, there is still a controversy over the lung protection of RIPC in patients who suffers different types of surgery. We undertook meta-analysis of the randomized controlled trials to evaluate the effect of remote ischemic preconditioning on clinical outcomes of patients with lung injury. ⋯ RIPC can decrease pulmonary inflammatory responses, reduce the duration of ICU and mechanical ventilation time, and improve the clinical outcomes of patients with lung injury.
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Review Meta Analysis
Analgesic efficacy of PECS vs paravertebral blocks after radical mastectomy: A systematic review, meta-analysis and trial sequential analysis.
Due to conflicting results published in the literature regarding the analgesic superiority between the paravertebral block and the PECS block, the study objective is to determine which one should be the first line analgesic treatment after radical mastectomy. ⋯ There is low quality evidence that a PECS block provides marginal postoperative analgesic benefit after radical mastectomy at 2 postoperative hours only, when compared with a paravertebral block, and not beyond. Clinical trial number: PROSPERO - registration number: CRD42019131555.
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Review Meta Analysis
Duloxetine for the treatment acute postoperative pain in adult patients: A systematic review with meta-analysis.
Duloxetine administered during the acute perioperative period has been associated with lesser postoperative pain and analgesic consumption. ⋯ Although statistically significant effects of duloxetine were found on postoperative pain and opioid consumption during the first 48 postoperative hours, the effect sizes were below the expected minimal clinically relevant differences. Also, high risk-of-bias and inter-study heterogeneity caused the very-low quality of evidence (GRADE). We conclude that the currently available evidence does not support the clinical use of duloxetine for the management of acute postoperative pain.
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Review Meta Analysis
Analgesic efficacy of PECS and serratus plane blocks after breast surgery: A systematic review, meta-analysis and trial sequential analysis.
To determine whether pectoral nerves (PECS) blocks provide effective postoperative analgesia when compared with no regional technique in patients undergoing breast surgery. ⋯ There is moderate-to-high level evidence that PECS blocks provide postoperative analgesia after breast surgery when compared with no regional technique and reduce rate of PONV. This might provide the most benefit to those at high-risk of postoperative pain.
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Low level of fibrinogen is a risk factor of perioperative bleeding, which is a major complication in surgical patients. However, the safety and efficacy of fibrinogen supplementation with fibrinogen concentrate to minimize postoperative bleeding remains unclear. ⋯ In this meta-analysis of 13 randomized trials, low level of evidence and substantial heterogeneity with small sample size limit strong recommendation on the use of fibrinogen concentrate in adult surgical patients. However, its use is tolerable without any notable adverse events.