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Day MS, Boryan A. Current Evidence-based Approaches to Multimodal Pain Control and Opioid Minimization After Arthroscopic and Knee Preservation Surgery. J Am Acad Orthop Surg 2024; 32:e24-e32. [PMID: 37611405 DOI: 10.5435/jaaos-d-23-00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Nonarthroplasty knee procedures are common and may cause a wide spectrum of postoperative pain, ranging from minimal to severe, depending on the patient, pathology, and procedure. Procedures include ligament repair and reconstruction, especially anterior cruciate ligament reconstruction, meniscal débridement, repair and transplant, periarticular osteotomy, and cartilage restoration. Multimodal analgesia regimens have been implemented successfully, but notable variation characterizes current protocols. Increased public and physician awareness of the burden of opioid usage in the United States has encouraged the medical community to embrace opioid-minimizing and nonopioid techniques to mitigate the deleterious effects of these medications. Nonopioid medications; anesthesia techniques; surgical techniques; and postoperative nonmedication strategies, including physical therapy, transcutaneous electrical nerve stimulation, cryotherapy, cognitive techniques, and non-Western interventions, can form part of an effective multimodal approach. A multimodal approach can facilitate adequate analgesia without compromising patient satisfaction or outcome.
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Affiliation(s)
- Michael Sean Day
- From the WellSpan Sports Medicine, WellSpan Chambersburg Orthopedic Surgery, WellSpan Health (Day), and the WellSpan Chambersburg Anesthesia, WellSpan Health, Chambersburg, PA (Boryan)
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Nesioonpour S, Mohtadi AR, Ghomeishi A, Savaie M, Pedram H, Poursalehan S, Esfahanian Y. Effect of Intra-articular Dexmedetomidine on Postoperative Pain after Knee Arthroscopic Surgery. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:272-277. [PMID: 35514766 PMCID: PMC9034798 DOI: 10.22038/abjs.2021.53942.2706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/15/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study aimed to prevent and control the pain after arthroscopy that leads to patient satisfaction, rehabilitation, and return to normal life as soon as possible. It is hypothesized that there is no difference between intra-articular injection of dexmedetomidine and placebo after knee arthroscopy regarding pain level. METHODS This double-blind randomized clinical trial was conducted on 70 patients aged 18-60 years who were candidates for elective knee arthroscopic surgery with the American Society of Anesthesiologists Classification I-II. All patients underwent spinal anesthesia equally and were randomly divided into two groups of 35 cases per group. The drug group (D) received 2 μg/kg dexmedetomidine with 0.9% normal saline reached to a volume of 20 ml, and 20 ml of 0.9% normal saline was injected into the knee joint through the cannular sheath in the control group (C). Postoperative pain intensity was recorded 1, 2, 4, 8, 16, 24 h after injection using the Visual Analogue Scale. The time of requesting the first analgesic and the amount of analgesics consumed were recorded after 24 h. RESULTS There was no significant difference between the two groups in terms of age, height, weight, duration of spinal anesthesia, and duration of surgery (P>0.05). In group D, there was a decrease in postoperative pain, a decrease in the amount of analgesic consumed, and an increase in the time of the first analgesic request, compared to group C (P<0.05). CONCLUSION This study showed that intra-articular injection of dexmedetomidine relieved postoperative pain, reduced analgesic consumption, and increased the time of first analgesic request after knee arthroscopy.
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Affiliation(s)
- Sholeh Nesioonpour
- Department of Anesthesiology,Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Mohtadi
- Department of Anesthesiology,Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Ghomeishi
- Department of Anesthesiology,Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohsen Savaie
- Department of Anesthesiology,Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hooman Pedram
- Department of Orthopedic Surgery, Shohadaye Naft Hospital, Susangerd, Iran
| | - Sara Poursalehan
- Department of Anesthesiology, Shohadaye Naft Hospital, Susangerd, Iran
| | - Yasaman Esfahanian
- Department of Anesthesiology,Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Huang L, Li P, Zhang L, Kang G, Zhou H, Zhao Z. Analgesic comparison between perineural and intravenous dexamethasone for shoulder arthroscopy: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2022; 17:103. [PMID: 35177116 PMCID: PMC8851776 DOI: 10.1186/s13018-022-02952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The analgesic comparison between perineural and intravenous dexamethasone on interscalene block for pain management after shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of perineural versus intravenous dexamethasone on interscalene block for pain control after shoulder arthroscopy. Methods We have searched PubMed, Embase, Web of science, EBSCO and Cochrane library databases through April 2021 and included randomized controlled trials (RCTs) assessing the effect of perineural and intravenous dexamethasone on interscalene block in patients with shoulder arthroscopy. Results Five RCTs were included in the meta-analysis. Overall, compared with intravenous dexamethasone for shoulder arthroscopy, perineural dexamethasone led to similar block duration (SMD = 0.12; 95% CI − 0.12 to 0.35; P = 0.33), pain scores at 12 h (SMD = − 0.67; 95% CI − 1.48 to 0.15; P = 0.11), pain scores at 24 h (SMD = − 0.33; 95% CI − 0.79 to 0.14; P = 0.17), opioid consumption (SMD = 0.01; 95% CI − 0.18 to 0.19; P = 0.95) and incidence of nausea/vomiting (OR = 0.74; 95% CI 0.38–1.44; P = 0.38). Conclusions Perineural and intravenous dexamethasone demonstrated comparable pain relief after shoulder arthroscopy.
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Affiliation(s)
- Liangku Huang
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Peng Li
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Liang Zhang
- Sports Medicine Center, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 555 Youyidong Street, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Guangming Kang
- Department of Hand Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Haizhen Zhou
- Department of Orthopaedic Oncology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, 710054, Shaanxi, China
| | - Zandong Zhao
- Sports Medicine Center, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 555 Youyidong Street, Beilin District, Xi'an, 710054, Shaanxi, China.
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Yang J, Ni B, Fu X. Efficacy of intra-articular ketorolac for pain control in arthroscopic surgeries: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:688. [PMID: 34809647 PMCID: PMC8607634 DOI: 10.1186/s13018-021-02833-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The current systematic review and meta-analysis aimed to synthesize evidence on the efficacy of intra-articular ketorolac for patients undergoing arthroscopic surgeries. METHODS PubMed, Embase, ScienceDirect, and Google Scholar databases were searched for randomized controlled trials assessing the analgesic effect of intra-articular ketorolac for arthroscopic surgery of hip/knee or shoulder joint. RESULTS Six studies were included. Two studies were on shoulder arthroscopy, while others were on knee joint. Meta-analysis revealed that patients receiving intra-articular ketorolac had significantly lower pain scores at 2-4 h (MD: - 0.58 95% CI: - 0.88, - 0.19 I2 = 49% p = 0.002), 6-8 h (MD: - 0.77 95% CI: - 1.11, - 0.44 I2 = 31% p < 0.00001), 12 h (MD: - 0.94 95% CI: - 1.21, - 0.67 I2 = 0% p < 0.00001), and 24 h (MD: - 1.28 95% CI: - 1.85, - 0.71 I2 = 84% p < 0.00001) as compared to the control group (Certainty of evidence: low-moderate). Analysis of three studies revealed a tendency of reduced analgesic consumption in patients receiving intra-articular ketorolac, but the difference did not reach statistical significance (MD: - 0.53 95% CI: - 1.07, 0.02 I2 = 55% p = 0.06). CONCLUSIONS Preliminary evidence from a limited number of studies indicates that additional intra-articular ketorolac to multimodal analgesia results in reduced pain scores up to 24 h after arthroscopic surgery. The clinical relevance of small changes in pain scores is debatable. Also, scarce data suggest that consumption of analgesics may not be reduced with intra-articular ketorolac. Since pain scores can be influenced by the primary diagnosis and dose of ketorolac, the results should be interpreted with caution. The certainty of the evidence is low-moderate. There is a need for future RCTs to further strengthen current evidence.
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Affiliation(s)
- Jingjing Yang
- Department of Pharmacy, Hangzhou Third People's Hospital, 38 Xihu Ave, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China
| | - Bin Ni
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Shangcheng District, Hangzhou, 310003, Zhejiang Province, China
| | - Xiaoyan Fu
- Department of Pharmacy, Hangzhou Third People's Hospital, 38 Xihu Ave, Shangcheng District, Hangzhou, 310009, Zhejiang Province, China.
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Guan X, Jiao Z, Gong X, Cao H, Liu S, Lan H, Huang X, Tan Y, Xu B, Lin C. Efficacy of Pre-Treatment with Remimazolam on Prevention of Propofol-Induced Injection Pain in Patients Undergoing Abortion or Curettage: A Prospective, Double-Blinded, Randomized and Placebo-Controlled Clinical Trial. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:4551-4558. [PMID: 34764637 PMCID: PMC8576108 DOI: 10.2147/dddt.s334100] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/22/2021] [Indexed: 12/03/2022]
Abstract
Background Propofol-induced injection pain (PIP) is a well-known problem in general anesthesia. We hypothesized that pre-treatment with remimazolam prevents PIP in patients undergoing abortion or curettage. Materials and Methods In this prospective, single-center, double-blinded, randomized, placebo-controlled clinical trial, adult patients aged 18 to 60 undergoing abortion or curettage were randomly assigned to three groups. Group Lido received system lidocaine (a bolus of 0.5 mg kg−1, iv). Group Remi received remimazolam (a bolus of 0.1 mg kg−1, iv). Group NS received identical volumes of 0.9% normal saline. Sixty seconds after the injection of lidocaine, remimazolam or saline, patients were injected with propofol at a rate of 12 mL/min until the loss of consciousness. The primary outcome was the incidence of PIP at the time of induction using 4-point scale. Secondary outcomes included propofol-induced injection pain, vital signs, the characteristics of anesthesia and surgery, and adverse events. Results The incidence of patients with PIP was higher in group NS than that in group Lido and group Remi (75.7, 44.3, and 42.9%, respectively, p < 0.001). The percentages of patients with moderate PIP were higher in group NS than that in group Lido and group Remi (20.0, 2.9, and 1.4%, respectively, p < 0.001). Moreover, the consumption of propofol and the incidence of adverse event (hypoxemia and chin lifting) in group Remi were lower than that in group NS and Lido, and less patients got physical movement and cough in group Remi. The recovery time in group NS was longer than that in group Lido and Remi. Conclusion Our findings indicate that pre-treatment with remimazolam reduced the incidence and intensity of PIP in abortion or curettage patients, equivalent to that of lidocaine without severe adverse effects. Trial Registration Chinese Clinical Trial Registry (identifier: ChiCTR2100041805).
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Affiliation(s)
- Xuehai Guan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Ziyin Jiao
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiaofang Gong
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Huiyu Cao
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Susu Liu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Hongmeng Lan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiaofang Huang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yanmeng Tan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Bing Xu
- Department of Rehabilitation, The People`s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China
| | - Chengxin Lin
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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Liu C, Cheng L, Du B, Cheng S, Jiang Y, Tan X, Qian K. The analgesic efficacy of pregabalin for shoulder arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e26695. [PMID: 34559094 PMCID: PMC8462647 DOI: 10.1097/md.0000000000026695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/19/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The efficacy of pregabalin for pain management of shoulder arthroscopy remains controversial. We conduct this meta-analysis to explore the influence of pregabalin versus placebo on the postoperative pain intensity of shoulder arthroscopy. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2019 for randomized controlled trials assessing the effect of pregabalin versus placebo on pain control of shoulder arthroscopy. This meta-analysis was performed using the random-effect model. RESULTS Three randomized controlled trials were included in the meta-analysis. Overall, compared with control group for shoulder arthroscopy, pregabalin remarkably decreased pain scores at 0 to 1 hour (Std. MD = -0.57; 95% CI = -1.04 to -0.09; P = .02) and 12 hours (Std. MD = -0.37; 95% CI = -0.72 to -0.02; P = .04), as well as analgesic consumption (Std. MD = -1.84; 95% CI = -2.24 to -1.44; P < .00001), but showed no notable influence on pain scores at 24 hours (Std. MD = -0.54; 95% CI = -1.47 to 0.38; P = .25), nausea or vomiting (RR = 0.84; 95% CI = 0.53-1.33; P = .45), dizziness (RR = 1.14; 95% CI = 0.89-1.47; P = .30). CONCLUSIONS Pregabalin may benefit to pain control after shoulder arthroscopy.
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Affiliation(s)
- Chunhong Liu
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
| | - Ling Cheng
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Bo Du
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
| | - Shuang Cheng
- Department of Surgery, The TCM Hospital of Kaizhou District, Chongqing, China
| | - Yangming Jiang
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Xiaohong Tan
- Department of Hepatological Surgery, The People's Hospital of Kaizhou District, Chongqing, China
| | - Ke Qian
- Department of Anesthesiology, People's Hospital of Chongqing Banan District
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Xie Z, Nie X, Pan L, Zhang N, Xue H. The Comparison of Intrathecal Ropivacaine with Bupivacaine for Knee Arthroscopy: A Meta-analysis of Randomized Controlled Trials. J Knee Surg 2021; 34:971-977. [PMID: 31952093 DOI: 10.1055/s-0039-3402795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The comparison of intrathecal ropivacaine with bupivacaine for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the efficacy of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through August 2019 for randomized controlled trials (RCTs) assessing the effect of intrathecal ropivacaine versus bupivacaine for knee arthroscopy. This meta-analysis is performed using the random effects model. Five RCTs are included in the meta-analysis. Overall, compared with intrathecal bupivacaine for knee arthroscopy, intrathecal ropivacaine is associated with increased onset time of motor block (mean difference [MD] = 2.05, 95% CI: 1.43-2.67, p < 0.00001) and decreased duration of sensory block (MD = -26.82, 95% CI: -31.96 to -21.67, p < 0.00001) but shows no remarkable influence on onset time of sensory block (MD = -0.09; 95% CI: -1.89 to 1.70, p = 0.92), duration of motor block (MD = -59.76; 95% CI: -124.44 to 4.91, p = 0.07), time to maximum block (MD = 2.35; 95% CI: -0.16 to 4.86, p = 0.07), first urination time (MD = -26.42, 95% CI: -57.34 to 4.51, p = 0.09), or first ambulation time (MD = 3.63, 95% CI: -25.20 to 32.47, p = 0.80).Intrathecal ropivacaine can substantially increase onset time of motor block and decrease the duration of sensory block than intrathecal bupivacaine for knee arthroscopy.
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Affiliation(s)
- Zhiwei Xie
- Department of Hand-foot and Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaoying Nie
- Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Linlin Pan
- Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Na Zhang
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Huiqin Xue
- Department of Nursing, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
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Huang F, Yang Z, Su Z, Gao X. The analgesic evaluation of gabapentin for arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e25740. [PMID: 34011032 PMCID: PMC8137103 DOI: 10.1097/md.0000000000025740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 04/07/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The efficacy of gabapentin for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of gabapentin versus placebo on the postoperative pain intensity of arthroscopy. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2020 for randomized controlled trials assessing the effect of gabapentin versus placebo on pain control of arthroscopy. This meta-analysis is performed using the random-effect model. RESULTS Five randomized controlled trials are included in the meta-analysis. Overall, compared with control group for arthroscopy, gabapentin remarkably decreases pain scores at 24 hour (standard mean difference [SMD]=-0.68; 95% confidence interval [CI]=-1.15 to -0.02; P = .21), analgesic consumption (SMD = -18.24; 95% CI=-24.61 to -11.88; P < .00001), nausea and vomiting (OR = 0.42; 95% CI = 0.21 to 0.84; P = .01), but has no obvious influence on pain scores at 6 h (SMD = -1.30; 95% CI = -2.92 to 0.31; P = .11) or dizziness (OR = 1.12; 95% CI = 0.56 to 2.24; P = .75). CONCLUSIONS Gabapentin is effective for pain control after arthroscopy.
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Affiliation(s)
- Feiri Huang
- Department of Orthopedics, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital
| | - Zhifang Yang
- Department of Orthopedics, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital
| | - Zhongliang Su
- Department of Orthopedics, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou People's Hospital
| | - Xiaosheng Gao
- Department of Orthopedics, Affiliated Yueqing Hospital,Wenzhou Medical University, Wenzhou, Zhejiang Province, P.R. China
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Lu JZ, Fu JX, Wang DF, Su ZL, Zheng YB. The efficacy of intra-articular fentanyl supplementation for knee arthroscopy: A meta-analysis of randomized controlled studies. J Orthop Surg (Hong Kong) 2020; 28:2309499019900274. [PMID: 31994976 DOI: 10.1177/2309499019900274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The efficacy of intra-articular fentanyl supplementation for pain control after knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of intra-articular fentanyl supplementation for pain intensity after arthroscopic knee surgery. METHODS We searched PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases through May 2019 for randomized controlled trials (RCTs) assessing the efficacy and safety of intra-articular fentanyl supplementation for arthroscopic knee surgery. This meta-analysis is performed using the random-effects model. RESULTS Four RCTs are included in the meta-analysis. Overall, compared with control group after knee arthroscopy, intra-articular fentanyl supplementation is associated with reduced pain scores at 1 h (standard mean difference (Std MD) = -3.50; 95% confidence interval (CI) = -5.68 to -1.32; p = 0.002), 2 h (Std MD = -4.73; 95% CI = -8.75 to -0.71; p = 0.02), and 8 h (Std MD = -5.02; 95% CI = -9.73 to -0.30; p = 0.04) but shows no substantial impact on pain scores at 4 h (Std MD = -3.94; 95% CI = -7.93 to 0.05; p = 0.05) or the supplementary analgesia (risk ratio = 0.56; 95% CI = 0.09-3.59; p = 0.54). CONCLUSIONS Intra-articular fentanyl supplementation does benefit in pain control after knee arthroscopy.
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Affiliation(s)
- Jian-Zuo Lu
- Department of Orthopedics, The People's Hospital of Wenzhou City, Wenzhou, Zhejiang, China
| | - Jia-Xing Fu
- Department of Orthopedics, The People's Hospital of Wenzhou City, Wenzhou, Zhejiang, China
| | - Da-Feng Wang
- Department of Orthopedics, The People's Hospital of Wenzhou City, Wenzhou, Zhejiang, China
| | - Zhong-Liang Su
- Department of Orthopedics, The People's Hospital of Wenzhou City, Wenzhou, Zhejiang, China
| | - Yuan-Bo Zheng
- Department of Orthopedics, The People's Hospital of Wenzhou City, Wenzhou, Zhejiang, China
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Peng C, Li C, Yuan B, Jiao J. The efficacy of dexamethasone on pain management for knee arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19417. [PMID: 32311920 PMCID: PMC7220723 DOI: 10.1097/md.0000000000019417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The impact of dexamethasone on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexamethasone for knee arthroscopy. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of dexamethasone on pain intensity for patients with dental implant. This meta-analysis is performed using the random-effect model. RESULTS Four RCTs involving 228 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, dexamethasone supplementation has no notable effect on pain scores at 4 to 6 hours (Std. MD = 0.99; 95% CI = -2.97 to 4.95; P = .62), but exerts significantly favorable promotion to pain scores at 12 hours (Std. MD = -1.06; 95% CI = -1.43 to -0.69; P < .00001), duration of block (Std. MD = 1.87; 95% CI = 0.65 to 3.10; P = .003), time to first analgesic requirement (Std. MD = 0.90; 95% CI = 0.51 to 1.29; P < .00001), analgesic consumption (Std. MD = -1.62; 95% CI = -2.31 to -0.93; P < .00001), and patient satisfaction (Std. MD = 1.15; 95% CI = 0.73 to 1.58; P < .00001). CONCLUSIONS Dexamethasone supplementation has importantly positive influence on pain control for knee arthroscopy.
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Wan R, Li P, Jiang H. The efficacy of celecoxib for pain management of arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17808. [PMID: 31804304 PMCID: PMC6919475 DOI: 10.1097/md.0000000000017808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The efficacy of celecoxib for pain management of arthroscopy remains controversial. We conduct a systematic review and meta-analysis to assess if celecoxib before the surgery decreases postoperative pain intensity of arthroscopy. METHODS We search PubMed, Embase, Web of science, EBSCO, and Cochrane library databases for randomized controlled trials (RCTs) assessing the effect of celecoxib versus placebo on pain control of arthroscopy. RESULTS Five RCTs are included in the meta-analysis. Celecoxib is administered at 200 mg or 400 mg dosage before the surgery. Overall, compared with control group for arthroscopy, preemptive celecoxib has remarkably positive impact on pain scores at 2 to 6 hours (standard mean difference (SMD) = -0.66; 95% confidence interval (CI) = -0.95 to -0.36; P < .0001) and 24 hours after the surgery (SMD = -1.26; 95% CI = -1.83 to -0.70; P < 0.0001), analgesic consumption (SMD = -2.73; 95% CI = -5.17 to -0.28; P = .03), as well as the decrease in adverse events (risk ratio (RR) = 0.56; 95% CI = 0.39 to 0.79; P = .001), but shows no obvious effect on first time for analgesic requirement (SMD = 0.02; 95% CI = -0.22 to 0.26; P = .87), nausea, or vomiting (RR = 0.70; 95% CI = 0.42 to 1.17; P = .18). CONCLUSION Celecoxib administered at 200 mg or 400 mg dosage before the surgery decreases postoperative pain intensity of arthroscopy.
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Affiliation(s)
| | - Pin Li
- Department of Orthopaedics
| | - Heng Jiang
- Department of Rehabilitation, Chongqing Traditional Chinese Medicine Hospital, China
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Pan L, Shen Y, Ma T, Xue H. The efficacy of ketamine supplementation on pain management for knee arthroscopy: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e16138. [PMID: 31277113 PMCID: PMC6635221 DOI: 10.1097/md.0000000000016138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The efficacy of ketamine supplementation on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine supplementation for knee arthroscopy. METHODS We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of ketamine supplementation on pain control for knee arthroscopy. This meta-analysis is performed using the random-effect model. RESULTS Seven RCTs involving 300 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, ketamine supplementation reveals favorable impact on pain scores (mean difference [MD] = -2.95; 95% confidence interval [CI] = -3.36 to -2.54; P < .00001), analgesic consumption (standard mean difference [Std. MD] = -1.03; 95% CI = -1.70 to -0.36; P = .002), time to first analgesic requirement (Std. MD = 1.21; 95% CI = 0.45-1.96; P = .002) and malondialdehyde (Std. MD = -0.63; 95% CI = -1.05 to 3.10; P = -.20), and shows no increase in nausea and vomiting (RR = 1.87; 95% CI = 0.65-3.10; P = .003). CONCLUSIONS Ketamine supplementation benefits to pain management and may reduce ischemia reperfusion injury in patients with knee arthroscopy.
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Affiliation(s)
- Linlin Pan
- Department of Traumatology of the Second Affiliated Hospital of Innmer Mongolia Medical University
| | - Yawen Shen
- Department of Traumatology of the Second Affiliated Hospital of Innmer Mongolia Medical University
| | - Teng Ma
- Nursing School of Inner Mongolia Medical University, Inner Monglia, China
| | - Huiqin Xue
- Nursing School of Inner Mongolia Medical University, Inner Monglia, China
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