Comparison of postoperative pain in children after maintenance anaesthesia with propofol or sevoflurane: a systematic review and meta-analysis

BACKGROUND

Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence is lower when propofol is used for maintenance of anaesthesia compared with sevoflurane, although this is not clear.

METHODS

This meta-analysis compared postoperative pain following maintenance of anaesthesia with propofol or sevoflurane in paediatric surgeries. PubMed Medline, Embase, Scopus, Web of Science and Cochrane Library were searched for randomised controlled trials (RCTs) that compared postoperative pain between sevoflurane and propofol anaesthesia in children. After quality assessment, a meta-analysis was carried out using bias-adjusted inverse heterogeneity methods, heterogeneity using I2 and publication bias using Doi plots.

RESULTS

In total, 13 RCTs with 1174 children were included. The overall synthesis suggested nearly two-fold higher odds of overall postoperative pain in the sevoflurane group compared with the propofol group (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.12-3.15, I2=58.2%). Further, children in the sevoflurane group had higher odds of having higher pain scores (OR 3.18, 95% CI 1.83-5.53, I2=20.9%), and a 60% increase in the odds of requiring postoperative rescue analgesia compared with propofol (OR 1.60, 95% CI 0.89-2.88, I2=58.2%).

CONCLUSIONS

Children maintained on inhalational sevoflurane had higher odds of postoperative pain compared with those maintained on propofol. The results also suggest that sevoflurane is associated with higher odds of needing postoperative rescue analgesia compared with propofol.

REGISTRATION

The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023445913.

Perceptions and Experiences of Pursuing Research Among Medical Students in Problem-Based Learning Curriculum: A Cross-Sectional Study from Qatar

OBJECTIVES

Early introduction to research prepares medical students for the practice of evidence-based medicine. Few studies have examined the experiences of research among medical students in the Arab region. This study assesses medical students' experiences in pursuing research at the national College of Medicine (CMED) in the state of Qatar.

METHODS

This cross-sectional study was conducted using an online questionnaire distributed through Google Forms. The inclusion criteria called for students over 18 years old enrolled in the college in Years 2 to 6 (pre-clinical and clinical phases) during the spring semester of 2022. The questionnaire included 5 sections with multiple-choice questions and 5-point Likert-scale questions. The questionnaire was validated using esperts review and by piloting it on 10% of the eligible students. STATA 17.0 was used to perform the statistical analysis, which involved a logistic regression and Mann-Whitney U test.

RESULTS

The study had 179 student participants (over half of the eligible group). Half were in the preclinical phase, and half were in the clinical phase. Approximately half had published at least 1 paper. For voluntary research, the main motivators were passion and positive past experiences, while the main demoralizer was inadequate time. For mandatory medical-student research, supervisor help was the main facilitator, and an academic load leaving insufficient time for research was the main barrier. The factors positively influencing voluntary research participation were being older, being male, studying in a more advanced program phase, and having a lower score for negative attitudes toward research. The main limitation of the study was the inclusion of only 1 medical school with 1 type of curriculum.

CONCLUSIONS

Our findings suggest that better research experience can be ensured by providing space, time, and proper academic and moral support to students. The authors believe that doing so will indirectly positively affect the future translation of skills in evidence-based medicine into clinical practice.