Objective To assess the efficacy and safety of dexmedetomidine used for intravertebral anesthesia. Methods A search in PubMed Central, EBSCO, Springer, Ovid, CNKI and WanFang Data was conducted from the date of their establishment to February 2011, so as to collect the randomized controlled trails (RCTs) on dexmedetomidine used for intravertebral anesthesia. The reference lists of identified papers were examined for further trials. After the data were extracted and the quality was assessed in accordance with the inclusion and exclusion criteria, the Meta-analysis was conducted with RevMan5.0 software. Results A total of 13 RCTs involving 672 patients were included. The results of meta-analyses showed that compared with saline solution, dexmedetomidine tended to speed up the mean time of sensory block to reach T10 dermatome (MD= –2.39, 95%CI –4.40 to –0.39) and motor block to reach Bromage 3 (MD= –5.30, 95%CI –7.18 to –3.43). It also prolonged the time for two dermatomes regression of sensory blockade (MD=51.14, 95%CI 44.96 to 57.32) and complete resolution of motor blockade (MD=68.46, 95%CI 38.56 to 98.35). Peri-operative bradycardia significantly increased (RR=3.03, 95%CI 1.64 to 5.59) but shivering decreased (RR=0.47, 95%CI 0.28 to 0.80). In comparison with the control group, dexmedetomidine showed no difference in low blood pressure and occurrence of postoperative nausea and vomiting. Conclusion The current evidence shows that dexmedetomidine shortens the time for taking effect, prolongs the duration of intravertebral anesthesia, decreases the occurrence of shivering, and increases the occurrence of bradycardia.
Objective To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus. Methods According to the Cochrane Handbook, such databases as The Cochrane Library, OVID, EMbase, PubMed, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) about ondansetron for preventing intrathecal opioid induced pruritus. According to the predefined inclusion and exclusion criteria, the literatures were screened, and meta-analysis was conducted by using RevMan 5.0 software. Results Eight RCTs involving 577 patients were included. The quality evaluation showed the bias of all studies was unclear. Meta-analysis showed that because the heterogeneity of the included studies was so large (P=0.0001, I2=80%), subgroup analyses were performed. The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups. a) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery (RR=0.49, 95%CI 0.35 to 0.67); b) There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery (RR=0.98, 95%CI 0.86 to 1.12); c) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery (RR=0.51, 95%CI 0.34 to 0.76); and d) There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery (RR=0.49, 95%CI 0.35 to 0.67). Conclusion The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee, urologic and gynecological surgeries rather than obstetric and outpatient surgeries. Due to the small scale, large heterogeneity and unclear quality evaluation of the included studies, more high quality RCTs are required to provide reliable evidence.
ObjectiveTo study the proper time of first postoperative eating in patients after orthopedic surgery with spinal anesthesia. MethodsA total of 160 patients who underwent orthopedic surgery from April 2012 to November 2014 were divided into trial group and control group.The symptoms of hunger, thirst, throat discomfort, vomiting and bloating were evaluated at hour 4 and 8 after surgery.The first oral feeding time and the incidence of constipation were analyzed and compared between the two groups. ResultsThe incidence of hunger and thirst in the trial group was significantly lower than that in the control group at hour 4 after surgery (P < 0.05).There was no significant difference in the incidence of throat discomfort, vomiting and bloating between the trial group and the control group at hour 4 and 8 after surgery (P > 0.05).Compared with the control group, the first time of oral feeding was significantly earlier (P < 0.05) and the incidence of constipation was significantly lower (P < 0.05) in the trial group. ConclusionWithout adverse reactions, early postoperative eating can alleviate the hunger and thirst sensation of patients after orthopedic surgery with spinal anesthesia, and reduce the incidence of constipation.
The traditional obstetric neuraxial anesthesia has no visual technical support. The success rate is closely related to the experience of the anesthesiologist, so there is a certain failure rate. With the widespread use of high-resolution portable ultrasound machines in recent years, a large number of clinical studies have upheld the feasibility and effectiveness of ultrasound in neuraxial anesthesia. The application of ultrasound in obstetric neuraxial anesthesia has obvious advantages compared with traditional methods of puncture. Ultrasound can accurately locate the intervertebral space, reduce the number of punctures, enhance the success rate of puncture, enhance the quality of obstetric anesthesia, and increase patients' satisfaction and comfort. This review shows the advantages and limitations of ultrasound in obstetric neuraxial anesthesia.
ObjectiveTo evaluate the clinical efficacy and safety of the inguinal approach versus classical pubic approach for obturator nerve block (ONB) in transurethral resection of bladder tumors (TUR-BT).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Web of Science, WanFang Data, CNKI and VIP databases were electronically searched to identify randomized controlled trials using ONB in TUR-BT from inception to May 2020. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using Stata 14.2 software.ResultsA total of 7 studies involving 474 patients were included. The meta-analysis results showed that there was no significant difference between inguinal approach and pubic approach in terms of the ONB success rate (RR=1.06, 95%CI 0.96 to 1.17, P=0.23), while the one-time success rate of puncture of inguinal approach was higher than that of pubic approach (RR=1.47, 95%CI 1.01 to 2.15, P=0.04). Compared with the pubic approach, the overall complications of inguinal approach were lower (RR=0.24, 95%CI 0.08 to 0.71, P=0.01). However, no significant difference was found between the two groups in terms of subcutaneous hematoma (RR=0.46, 95%CI 0.08 to 2.66, P=0.38).ConclusionsThe current evidence indicates that the success rate of one puncture of inguinal approach is higher than that of pubic approach, and the overall complications of the inguinal approach are much lower than that of the pubic approach. However, the above conclusions are still required to be verified through more high-quality studies due to the limited quantity and quality of included studies.