Articles: anesthetics.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisOpioid antagonists under heavy sedation or anaesthesia for opioid withdrawal.
Withdrawal (detoxification) is necessary prior to drug-free treatment or as the end point of long-term substitution treatment. ⋯ Heavy sedation compared to light sedation does not confer additional benefits in terms of less severe withdrawal or increased rates of commencement on naltrexone maintenance treatment. Given that the adverse events are potentially life-threatening, the value of antagonist-induced withdrawal under heavy sedation or anaesthesia is not supported. The high cost of anaesthesia-based approaches, both in monetary terms and use of scarce intensive care resources, suggest that this form of treatment should not be pursued.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisAdjusting the pH of lidocaine for reducing pain on injection.
Lidocaine administration produces pain due to its acidic pH. ⋯ Increasing the pH of lidocaine decreased pain on injection and augmented patient comfort and satisfaction.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisTopical agents or dressings for pain in venous leg ulcers.
Venous leg ulcers affect up to 1 per cent of people at some time in their lives. The main treatments are compression bandages and dressings. As these ulcers are often painful some clinicians choose particular dressings and topical treatments (analgesia/ local anaesthetic) to reduce the pain both during and between dressing changes. ⋯ There is no evidence that ibuprofen dressings offer pain relief, as measured at the first evening of use, to people with painful venous leg ulcers compared with foam dressings or best practice.EMLA appears to provide effective pain relief for venous leg ulcer debridement but the effect (if any) of EMLA on ulcer healing remains unknown.
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Review Meta Analysis
A meta analysis of treating subarachnoid hemorrhage with magnesium sulfate.
Despite the publication of several randomized controlled studies, there is still much debate on whether magnesium sulfate improves outcome in patients with aneurysmal subarachnoid hemorrhage. Here we present data to assess the clinical effectiveness of magnesium sulfate in the prevention of cerebral vasospasm in patients who have suffered from aneurysmal subarachnoid hemorrhage. The EMBASE and PubMed databases were searched using the following terms: "magnesium sulfate" or "MgSO(4)" with "subarachnoid hemorrhage" or "cerebral vasospasm". ⋯ The occurrence of poor outcome (death, vegetative state, or dependency) in patients treated with magnesium sulfate was less likely than control group patients (odds ratio [OR] 0.54 [95% confidence interval, CI 0.36-0.81]). Mortality rates did not differ between magnesium sulfate (14%) and control treated (12%) patients (OR 1.16 [95% CI 0.51-2.65]). Our results indicate that although there was reduced likelihood of a poor outcome for patients treated with magnesium sulfate after SAH, patient mortality was not improved.
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Review Meta Analysis
Meta-analysis: does lidocaine gel before flexible cystoscopy provide pain relief?
To consolidate previous reports and conduct a meta-analysis to draw further conclusions on the efficacy of the instillation of lidocaine gel before flexible cystoscopy, as it has had varying efficacy in several randomized controlled studies. ⋯ These data suggest that intraurethral instillation of lidocaine gel vs plain lubricating gel reduces the likelihood of moderate to severe pain during flexible cystoscopy.