Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials

OBJECTIVES: To determine the analgesic effectiveness, the effect on physical function and the safety of opioids in patients with osteoarthritis (OA). SEARCH STRATEGY: A systematic literature search was performed in electronic databases up to October 2006. A hand search of references was also performed. SELECTION CRITERIA: All randomized controlled trials evaluating the efficacy and/or the safety of opioids vs placebo or non-opioid analgesics in patients with OA were selected. DATA COLLECTION AND ANALYSIS: Data were collected using a predetermined form. Statistical analysis determined in each trial the effect size to assess the magnitude of treatment effect and the number needed to harm (NNH) to evaluate opioids safety. MAIN RESULTS: Eighteen randomized placebo-controlled trials were analyzed, i.e., a total of 3244 participants who received opioids and 1612 who received placebo. The mean trial duration was 13+/-18 weeks. The pooled effect sizes of all opioids vs placebo for pain intensity and physical function were -0.79 (95% confidence interval, CI, -0.98 to -0.59) and -0.31 (95% CI -0.39 to -0.24), respectively. The NNH was calculated to be 5 vs placebo. The number of studies (n=4) that compared opioids with non-opioid analgesics (paracetamol and non-steroidal anti-inflammatory drugs) was too limited to provide robust data. CONCLUSIONS: Opioids significantly decrease pain intensity and have small benefits on function compared with placebo in patients with OA. Adverse events, although reversible and not life threatening, often cause participants to stop taking the medication and could limit opioid usefulness. Moreover, the long-term efficacy and safety of these drugs for OA is yet to be determined due to the short mean trial duration.     

Prophylactic mesh reinforcement for midline incisional hernia prevention: systematic review and updated meta-analysis of randomized controlled trials

Hernia - Incisional hernia (IH) is a common complication after abdominal surgery. Prevention of IH is matter of intense research. Prophylactic mesh reinforcement (PMR) has been shown to be...     

Efficacy and safety of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia: A meta-analysis with trial sequential analysis of 23 randomised controlled trials

To further identify the real efficacy and safety of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia, we conducted this meta-analysis. The systematic search strategy was performed using PubMed, Embase, Cochrane Library, and Chinese databases. As a result, a total of 23 RCTs (1445 patients) were included. Patients receiving dexmedetomidine combined with local anaesthetics had a lower rescue analgesia rate [risk ratio (RR): 0.48; 95% confidence interval (CI): 0.36-0.65] and lower rescue analgesic consumption [weighted mean difference (WMD): −10.80 mg; 95%CI: −13.28 to −8.31 mg] than patients receiving local anaesthetics alone. The dexmedetomidine-related adverse reactions included bradycardia (RR: 1.33; 95%CI: 0.32-5.56) and hypotension (RR: 3.00; 95%CI: 0.49-18.42). In addition, the time to first analgesic request (WMD: 296.16 minutes; 95%CI: 165.69 minutes ~ 426.63 minutes), incidence of postoperative nausea and vomiting (PONV) and pain scores at 4 hours postoperatively were also significantly lower in patients receiving dexmedetomidine combined with local anaesthetics. This meta-analysis demonstrated that the use of dexmedetomidine as an adjuvant to wound infiltration is effective for reducing the rescue analgesia rate, rescue analgesic consumption and PONV. In addition, limited evidence shows that dexmedetomidine can prolong postoperative analgesia for approximately 5 hours. Further investigations on dexmedetomidine-related adverse reactions and the dose–response effect of dexmedetomidine in wound infiltration are warranted.     

Citrate versus heparin lock for prevention of hemodialysis catheter-related complications: updated systematic review and meta-analysis of randomized controlled trials

International Urology and Nephrology - To provide updated evidence, we conducted a systematic review and meta-analysis to compare citrate lock with heparin in the prevention of hemodialysis...     

Risk of fracture with thiazolidinediones: An updated meta-analysis of randomized clinical trials

ObjectiveThe use of thiazolidinediones (TZDs) has been associated with increased fracture risk. We performed a comprehensive literature review and meta-analysis to estimate the risk of fractures with TZDsMethodsWe searched MEDLINE, Embase and the Cochrane Database, from inception to May 2014. We included all randomized trials that described the risk of fractures or changes in bone mineral density (BMD) with TZDs. We pooled data with odds ratios (ORs) for fractures and the weighted mean difference in BMD. To assess heterogeneity in results of individual studies, we used Cochran's Q statistic and the I² statistic.ResultsWe included 24,544 participants with 896 fracture cases from 22 randomized controlled trials. Meta-analysis showed that the significantly increased incidence of fracture was found in women (OR = 1.94; 95%CI: 1.60–2.35; P < 0.001), but not in men (OR = 1.02; 95%CI: 0.83–1.27; P = 0.83). For women, the fracture risk was similar in rosiglitazone (OR = 2.01; 95%CI: 1.61–2.51; P < 0.001) and pioglitazone (OR = 1.73; 95%CI: 1.18–2.55; P = 0.005) treatment and appeared to be similar for participants aged < 60 years old (OR = 1.89; 95%CI: 1.51–2.36; P < 0.001) and aged ≥ 60 years old (OR = 2.07; 95%CI: 1.51–2.36; P < 0.001). There was a non-significant trend towards increased risk of fractures in different cumulative durations of TZD exposure. TZD treatment was also associated with significant changes in BMD among women at the lumbar spine(weighted mean difference: − 0.49%, 95%CI: − 0.66% to − 0.32%; P < 0.001), the femoral neck (weighted mean difference: − 0.34%, 95%CI: − 0.51% to − 0.16%; P < 0.001) and the hip(weighted mean difference: − 0.33%, 95%CI: − 0.52% to − 0.14%; P < 0.001).ConclusionsOur results suggest that TZD treatment is associated with an increased risk of fractures in women, effects of rosiglitazone and pioglitazone are similar, fracture risk is independent of age and fracture risk has no clear association with duration of TZD exposure.     

Umbilical port versus epigastric port for gallbladder extraction in laparoscopic cholecystectomy: A systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

BackgroundAfter laparoscopic cholecystectomy, gallbladder can be extracted either from epigastric/subxiphoid port or umbilical port. We conducted systematic review of randomized controlled trials comparing the two.MethodsPRISMA-compliant systematic review and meta-analysis was conducted with pre-specified study protocol registered on PROSPERO (CRD42019128662). Multiple databases were searched from inception till 14 September 2019 using search terms “gallbladder”, “specimen”, “extraction’, “extract”, “cholecystectomy”, “epigastric port”, “subxiphoid port” “umbilical port”. Outcomes assessed were postoperative pain (visual analog scale at 24 h postoperatively), port-site hernia, port-site infection, operative time and gallbladder retrieval time. Data were analyzed using random-effects models with risk ratios (RR) for dichotomous variables and mean difference (MD) for continuous variables.ResultsOf 280 articles retrieved, 9 RCT's with 1036 participants were included. Quality of included studies was judged to be “moderate” to “low”. There was no difference in postoperative pain at 24 h (p = 0.76), total operative time (p = 0.11), gallbladder retrieval time (p = 0.72) or surgical site infection (p = 0.93). Umbilical port retrieval was associated with significantly higher risk of port-site herniae (RR 2.68, 95%CI:1.06–6.80, p = 0.04). After sensitivity analysis, operative time was significantly shorter with epigastric retrieval (p = 0.0007). Trial sequential analysis showed that current studies were successful in achieving optimum information size for primary outcome.ConclusionsThere was no difference in postoperative pain and infections between umbilical and epigastric port retrieval. Umbilical port retrieval was associated with significantly higher risk of developing port-site hernia and could also be associated with longer operative time. Epigastric port may be favorable for gallbladder retrieval in multiport laparoscopic cholecystectomy.     

Efficacy and safety of tacrolimus combined with corticosteroids in patients with idiopathic membranous nephropathy: a systematic review and meta-analysis of randomized controlled trials

International Urology and Nephrology - To explore the efficacy and safety of tacrolimus (TAC) combined with corticosteroids in patients with idiopathic membranous nephropathy (IMN). A literature...     

Airway nerve blocks for awake tracheal intubation: A meta-analysis of randomized control trials and trial sequential analysis

Study objectiveThis systematic review and meta-analysis aimed to assess the superiority of airway nerve blocks versus airway anesthesia without nerve blocks for awake tracheal intubation (ATI).DesignSystematic review and meta-analysis of randomized controlled trials (RCTs).SettingAll studies that assessed the superiority of airway anesthesia technique for awake tracheal intubation were searched in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang database, and VIP databases) and trial registry databases from their inception to December 2022.PatientsAdult patients included in randomized controlled trials comparing airway anesthesia with or without airway nerve blocks for ATI.InterventionsAirway nerve (including superior laryngeal nerve, glossopharyngeal nerve, or recurrent laryngeal nerve) blocks for ATI.MeasurementsThe primary outcome was the intubation time. Secondary outcomes were quality of intubating conditions (including patient reaction to placement of the flexible scope and tracheal tube, coughing and gagging, and patient satisfaction) and overall complications during ATI.Main resultsFourteen articles with 658 patients were identified for analysis. When compared with airway anesthesia without nerve blocks, airway nerve blocks significantly reduced intubation time (standardized mean difference [SMD] -2.57, 95% CI -3.59- -1.56, p < 0.00001), improved anesthesia quality of ATI with higher no reaction to placement of the flexible scope and tracheal tube (relative risk [RR] 9.87; 95% CI 4.10–23.75, p < 0.00001), lower cough or gag reflex during intubation (RR 0.35, 95% CI 0.27–0.46, p < 0.00001), higher excellent patient satisfaction rate (RR 1.88, 95% CI 1.05–3.34, p = 0.03), and lower overall complications (RR 0.29, 95% CI 0.19–0.45, p < 0.00001). The overall quality of evidence was moderate.ConclusionsBased on current published evidence, airway nerve blocks provide better airway anesthesia quality for ATI with a shorter intubation time, better intubation conditions including higher no reaction to placement of the flexible scope and tracheal tube, lower cough or gag reflex during intubation, higher excellent patient satisfaction, and lower overall complications.     

Efficacy and safety of mycophenolate mofetil in the treatment for IgA nephropathy: a meta-analysis of randomized controlled trials

Clinical and Experimental Nephrology - IgA nephropathy is virtually known as the most common glomerulopathy to end-stage renal failure in the world. Mycophenolate mofetil is a selective...     

Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials

Background and objectiveSugammadex has been introduced for reversal of rocuronium (or vecuronium)–induced neuromuscular blockade (NMB). Although its efficacy has been established, data are conflicting whether it is safer than neostigmine traditionally used for reversing NMB.DesignMeta-analysis of data about effectiveness and safety of sugammadex compared to neostigmine for reversing NMB in adults was performed using the PRISMA methodology.SettingUniversity medical hospital.MethodsA comprehensive search was conducted using PubMed, Web of Science, and Cochrane Library electronic databases to identify English-language randomized controlled trials. Two reviewers independently selected the trials; extracted data on reversal times, incomplete reversals of NMB, and adverse events (AEs); and assessed the trials' methodological quality and evidence level. Only AEs that were related to study drug by a blinded safety assessor were considered for meta-analysis.PatientsA total of 1384 patients from 13 articles were included in this meta-analysis.Main resultsCompared to neostigmine, sugammadex was faster in reversing NMB (P < .0001) and more likely to be associated with higher train-of-four ratio values at extubation (mean difference, 0.18; 95% confidence interval [CI], 0.14-0.22; P < .0001) and lower risk of postoperative residual curarization after extubation (odds ratio [OR], 0.05; 95% CI, 0.01-0.43; P = .0068). Compared to neostigmine, sugammadex was associated with a significantly lower likelihood of global AEs (OR, 0.47; 95% CI, 0.34-0.66; P < .0001), respiratory AEs (OR, 0.36; 95% CI, 0.14-0.95; P = .0386), cardiovascular AEs (OR, 0.23; 95% CI, 0.08-0.61; P = .0036), and postoperative weakness (OR, 0.45; 95% CI, 0.21-0.97; P = .0409). Sugammadex and neostigmine were associated with a similar likelihood of postoperative nausea and vomiting (OR, 1.23; 95% CI, 0.70-2.15; P = .4719), pain (OR, 1.06; 95% CI, 0.15-7.36; P = .9559), neurologic AEs (OR, 1.47; 95% CI, 0.52-4.17; P = .4699), general AEs (OR, 0.75; 95% CI, 0.47-1.21; P = .2448), and changes in laboratory tests' values (OR, 0.57; 95% CI, 0.18-1.78; P = .3368).ConclusionsResults from this meta-analysis suggest that sugammadex is superior to neostigmine, as it reverses NMB faster and more reliably, with a lower risk of AEs.     

Efficacy and safety of videolaryngoscopy versus direct laryngoscopy in paediatric intubation: A meta-analysis of 27 randomized controlled trials

ObjectiveAnatomical and physiological differences in paediatric and adult airways make intubation of paediatric patients a challenge. This study aimed to compare the efficacy and safety of video laryngoscopy (VL) to direct laryngoscopy (DL) on intubation outcomes in paediatric patients.DesignSystematic review and meta-analysis.SettingOperating room.PatientsPaediatric patients who needed tracheal intubation.InterventionVideo laryngoscopy or direct laryngoscopy.MeasurementsElectronic searches in PubMed, Embase, and the Cochrane Library were performed to identify relevant randomized controlled trials published through January 2020. Outcomes included time to intubate, intubation failure at first attempt, Cormack-Lehane laryngeal view grade, intubation difficulty scale (IDS), percentage of glottic opening score (POGO), optimal external laryngeal manipulation (OLEM), and complications. Relative risks and weighted mean difference (WMD), with 95% CI, were employed to calculate summary results using a random-effects model.Main resultsOverall, 27 trials including 2461 paediatric patients were analysed. Children with video laryngoscopy intubation required longer time to intubate than direct laryngoscopy intubation (WMD 3.41, 95% CI: 1.29–5.53, P = 0.002), whereas infants receiving video laryngoscopy and direct laryngoscopy intubation experienced similar time to intubate (WMD 1.72, 95% CI: −1.09-4.54, P = 0.230). No significant differences were observed on intubation failure at first attempt between video laryngoscopy and direct laryngoscopy intubations in children and infants, respectively. Video laryngoscopy improved the POGO and intubation trauma but not Cormack-Lehane laryngeal view grade, IDS, external laryngeal manipulation, hoarseness, or oxygen desaturation.ConclusionsCompared with direct laryngoscopy intubation, there were no benefits for paediatric patients with video laryngoscopy on time to intubate and failure at first attempt, but there were benefits with regard to POGO and intubation trauma.     

Efficacy and safety of sclerosants in the treatment of venous malformations: A network meta-analysis of randomized controlled trials

Background: Venous malformations(VMs) are the most common low-flow vascular malformations. Although various sclerosants are effective, their relative effects have not yet been well established.Methods: We searched the Pub Med, Embase, Cochrane Library, Scopus, and Web of Science databases for randomized clinical trials up to April 1, 2021. We estimated odds ratios using pairwise analysis and network metaanalysis(NMA) with random-effects. We calculated the surface under the cumulative ranking cur...     

应用小剂量右美托咪定预防老年髋骨折患者术后谵妄的前瞻性随机对照研究

目的 探讨应用小剂量右美托咪定预防老年髋骨折患者术后谵妄的有效性与安全性.方法 采用前瞻性随机对照研究方法.纳入2019年7月至2020年9月北京大学第四临床医学院北京积水潭医院重症医学科(ICU)收治的老年髋骨折术后患者127例,中位年龄86(83,89)岁.患者接受手术方式包括全髋关节置换术19例(15.0％),半...     

Efficacy of quadratus lumborum block for analgesia in adult participants undergoing hip surgery: A meta-analysis of randomized controlled trials

Study objectiveThis study aimed to identify the benefits of quadratus lumborum block (QLB) in terms of postoperative analgesic effects in adult participants undergoing hip surgery.DesignMeta-analysis of randomized controlled trials.SettingPrevious randomized controlled trials that evaluated the analgesic effect of QLB compared to that of no block.PatientsNine studies including 616 participants.InterventionsParticipants in the treatment group received QLB, whereas those in the control group received no block.MeasurementsOutcomes were postoperative 24-h opioid consumption (primary), 12-h/24-h visual analog scale (VAS) or numeric rating scale (NRS) pain scores, postoperative nausea and vomiting (PONV), and satisfaction. The effect size was estimated using the standardized mean difference (SMD), mean difference (MD), or risk ratio (RR) with a 95% confidence interval (CI). We used the risk of bias tool (RoB 2) to assess the risk of bias of the included studies and the GRADE approach to determine the level of certainty of the evidence.Main resultsCompared to no block, the QLB group has less opioid consumption (SMD -1.69, 95% CI -2.54 to ‐0.84; low level of certainty of the evidence). Estimated MD for morphine consumption was 24 mg. The QLB group had a lower 12-h VAS/NRS pain score (MD -1.16, 95% CI -1.82 to ‐0.51; moderate level of certainty of the evidence) and 24-h VAS/NRS pain score (MD -0.92, 95% CI -1.42 to ‐0.43; moderate level of certainty of the evidence). QLB decreased the incidence of PONV (RR 0.43, 95% CI 0.24 to 0.79; moderate level of certainty of the evidence) and increased participants' satisfaction (SMD 1.15, 95% CI 0.63 to 1.67; moderate level of certainty of the evidence). Estimated MD for satisfaction was 1.74 points of Likert scale. There were no significant adverse events associated with the QLB in any of the included trials.ConclusionOur meta-analysis showed that QLB when compared to no block clinically decreased opioid requirements, reduced PONV, and improved participants' satisfaction. QLB also seems to be significantly superior to no block in terms of pain score, but its clinical importance remains unclear.