Cochrane Db Syst Rev
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The use of muscle relaxants in the management of non-specific low back pain is controversial. It is not clear if they are effective, and concerns have been raised about the potential adverse effects involved. ⋯ Muscle relaxants are effective in the management of non-specific low back pain, but the adverse effects require that they be used with caution. Trials are needed that evaluate if muscle relaxants are more effective than analgesics or non-steroidal anti-inflammatory drugs.
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Cochrane Db Syst Rev · Jan 2003
ReviewCaudal epidural block versus other methods of postoperative pain relief for circumcision in boys.
Circumcision is a commonly performed surgical procedure in boys and caudal analgesia is frequently used to minimize discomfort of penile surgery postoperatively. For humanitarian and physiological reasons pain should be anticipated and effectively controlled while ensuring patient safety. Several non-caudal analgesic techniques can be used including: penile block, systemic opioids and topical local anaesthetic cream,emulsion or gel. ⋯ Few studies compare caudal analgesia with other commonly available methods of analgesia in boys having circumcision surgery. Although the need for rescue analgesia is reduced in the early postoperative period when caudal is compared with parenteral analgesia,evidence from trials may no longer reflect current practice and is limited by small numbers and poor methodology. There is a need for properly designed trials to study the relative efficacy of caudal epidural with other methods such as penile block, morphine, simple analgesics and topical local anaesthetic cream,emulsions or gel.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisAntithrombotic agents for preventing thrombosis after infrainguinal arterial bypass surgery.
Chronic peripheral arterial disease (PAD) is frequently treated by implantation of either an infrainguinal autologous venous or artificial graft. One-year occlusion rates for infrainguinal bypasses vary between 15 and 75%, depending on the site of distal anastomosis, length, quality, and material of the graft, but also on other factors such as proximal inflow and distal outflow conditions. To prevent graft occlusion, patients are usually treated with either an antiplatelet or antithrombotic drug, or a combination of both. Little is known about which drug is optimal to prevent infrainguinal graft occlusion. ⋯ Patients operated for an infrainguinal venous graft might benefit from treatment with VKA, whereas patients receiving an artificial graft might profit more from platelet inhibitors (aspirin). However, the evidence is not conclusive. Randomised controlled trials with larger patient numbers comparing antithrombotic therapies with either placebo or antiplatelet therapies are called for in the future.
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Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. ⋯ Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes from randomised controlled trials. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. No trials of treatments for hyperemesis gravidarum show any evidence of benefit. Evidence from observational studies suggests no evidence of teratogenicity from any of these treatments.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisFluoride mouthrinses for preventing dental caries in children and adolescents.
Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and individually at home. ⋯ This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.25 D(M)FS per year, 16 children will need to use a fluoride mouthrinse (rather than a non-fluoride rinse) to avoid one D(M)FS; in populations with a caries increment of 2.14 D(M)FS per year, 2 children will need to rinse to avoid one D(M)FS. There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials.