Prolonging the duration of single-shot intrathecal labour analgesia with morphine: A systematic review

2016 ◽  
Vol 13 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hadeel Al-Kazwini ◽  
Irene Sandven ◽  
Vegard Dahl ◽  
Leiv Arne Rosseland
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Pain Relief ◽  
Beneficial Effect ◽  
Intrathecal Morphine ◽  
Meta Analysis ◽  
Labour Analgesia ◽  
Single Shot ◽  
Standardized Mean Difference

AbstractBackground and aimsSingle-shot spinal with bupivacaine plus fentanyl or sufentanil is commonly used as analgesia during labour, but the short duration limits the clinical feasibility. Different drugs have been added to prolong the analgesic duration. The additional effect of intra-thecal morphine has been studied during labour pain as well as after surgery. We assessed whether adding morphine to intra-thecal bupivacaine + fentanyl or sufentanil prolongs pain relief during labour.MethodsMeta-analysis of placebo-controlled randomized clinical trials of analgesia prolongation after single-shot intrathecal morphine ≤250µg during labour when given in combination with bupivacaine + fentanyl or sufentanil. After identifying 461 references, 24 eligible studies were evaluated after excluding duplicate publications, case reports, studies of analgesia after caesarean delivery, and epidural labour analgesia. Mean duration in minutes was the primary outcome measure and was included in the calculation of the standardized mean difference. Duration was defined as the time between a single shot spinal until patient request of rescue analgesia. All reported side effects were registered. Results of individual trials were combined using a random effect model. Cochrane tool was used to assess risk of bias.ResultsFive randomized placebo-controlled clinical trials (286 patients) were included in the metaanalysis. A dose of 50–250µg intrathecal morphine prolonged labour analgesia by a mean of 60.6 min (range 3–155 min). Adding morphine demonstrated a medium beneficial effect as we found a pooled effect of standardized mean difference = 0.57 (95% CI: –0.10 to 1.24) with high heterogeneity (I2 =88.1%). However, the beneficial effect was statistically non-significant (z =1.66, p = 0.096). The lower-bias trials showed a small statistically non-significant beneficial effect with lower heterogeneity. In influential analysis, that excluded one study at a time from the meta-analysis, the effect size appears unstable and the results indicate no robustness of effect. Omitting the study with highest effects size reduces the pooled effect markedly and that study suffers from inadequate concealment of treatment allocation and blinding. Trial quality was generally low, and there were too few trials to explore sources of heterogeneity in meta-regression and stratified analyses. In general, performing meta-analyses on a small number of trials are possible and may be helpful if one is aware of the limitations. As few as one more placebo-controlled trial would increase the reliability greatly.ConclusionsEvidence from this systematic review suggests a possible beneficial prolonging effect of adding morphine to spinal analgesia with bupivacaine + fentanyl or +sufentanil during labour. The study quality was low and heterogeneity high. No severe side effects were reported. More adequately-powered randomized trials with low bias are needed to determine the benefits and harms of adding morphine to spinal local anaesthetic analgesia during labour.ImplicationsEpidural analgesia is documented as the most effective method for providing pain relief during labour, but from a global perspective most women in labour have no access to epidural analgesia. Adding morphine to single shot spinal injection of low dose bupivacaine, fentanyl or sufentanil may be efficacious but needs to be investigated.

The effects and side effects of laquinimod for the treatment of multiple sclerosis patients: a systematic review and meta-analysis of clinical trials

2020 ◽  
Vol 76 (5) ◽  
pp. 611-622 ◽  
Author(s):  
Faeze Rouhi ◽  
Zinat Mohammadpour ◽  
Sakineh Kazemi Noureini ◽  
Hedayat Abbastabar ◽  
Mohammad Hossein Harirchian ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Meta Analysis ◽  
Multiple Sclerosis Patients

scholarly journals Randomized Controlled Trials of Early Ambulatory Hydroxychloroquine in the Prevention of COVID-19 Infection, Hospitalization, and Death: Meta-Analysis

2020 ◽  
Author(s):  
Joseph A. Ladapo ◽  
John E. McKinnon ◽  
Peter A. McCullough ◽  
Harvey Risch
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled ◽  
Exposure Prophylaxis

Objective--To determine if hydroxychloroquine (HCQ) reduces the incidence of new illness, hospitalization or death among outpatients at risk for or infected with SARS-CoV-2 (COVID-19). Design--Systematic review and meta-analysis of randomized clinical trials. Data sources--Search of MEDLINE, EMBASE, PubMed, medRxiv, PROSPERO, and the Cochrane Central Register of Controlled Trials. Also review of reference lists from recent meta-analyses. Study selection--Randomized clinical trials in which participants were treated with HCQ or placebo/standard-of-care for pre-exposure prophylaxis, post-exposure prophylaxis, or outpatient therapy for COVID-19. Methods--Two investigators independently extracted data on trial design and outcomes. Medication side effects and adverse reactions were also assessed. The primary outcome was COVID-19 hospitalization or death. When unavailable, new COVID-19 infection was used. We calculated random effects meta-analysis according to the method of DerSimonian and Laird. Heterogeneity between the studies was evaluated by calculation of Cochran Q and I2 parameters. An Egger funnel plot was drawn to investigate publication bias. We also calculated the fixed effects meta-analysis summary of the five studies. All calculations were done in Excel, and results were considered to be statistically significant at a two-sided threshold of P=.05. Results--Five randomized controlled clinical trials enrolling 5,577 patients were included. HCQ was associated with a 24% reduction in COVID-19 infection, hospitalization or death, P=.025 (RR, 0.76 [95% CI, 0.59 to 0.97]). No serious adverse cardiac events were reported. The most common side effects were gastrointestinal. Conclusion--Hydroxychloroquine use in outpatients reduces the incidence of the composite outcome of COVID-19 infection, hospitalization, and death. Serious adverse events were not reported and cardiac arrhythmia was rare. Systematic review registration--This review was not registered.

scholarly journals Vaginal dinoprostone versus placebo for pain relief during intrauterine device insertion: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Ahmed Abu-Zaid ◽  
Majed S. Alshahrani ◽  
Nisreen A. Albezrah ◽  
Najlaa T. Miski ◽  
Saud A. Aboudi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Side Effects ◽  
Pain Relief ◽  
Meta Analysis ◽  
Intrauterine Device ◽  
Cochrane Library ◽  
Pain Patient ◽  
Controlled Trials ◽  
Uterine Perforation

AbstractObjectiveTo investigate the safety and efficacy of vaginal dinoprostone versus placebo in pain relief during intrauterine device (IUD) insertion.DesignSystematic review and meta-analysis of randomized placebo-controlled trials.SettingNot applicable.Patient(s)Women undergoing IUD insertion and receiving vaginal dinoprostone or placebo.Intervention(s)PubMed, Scopus, Web of Science, and Cochrane Library were screened from inception to 01-October-2020, using the following search strategy: (dinoprostone OR cervidil OR prepidil) AND (intrauterine device OR iud).Main outcome measure(s)IUD insertion related pain, patient satisfaction, provider ease of IUD insertion, and side effects.Result(s)Five studies met the study inclusion criteria, comprising 862 patients; equally 431 patients received vaginal dinoprostone and placebo. All studies had an overall low risk of bias. When compared to placebo, dinoprostone significantly correlated with decreased pain at tenaculum placement (SMD=−0.79, 95% CI [−1.43, −0.16], p=0.01), decreased pain at uterine sounding (SMD=−0.88, 95% CI [−1.54, −0.22], p=0.009), decreased pain at IUD insertion (SMD=−1.18, 95% CI [−1.74, −0.61], p<0.001), decreased need for additional analgesia (RR=0.34, 95% CI [0.22, 0.53], p<0.001), increased patient satisfaction (SMD=1.41, 95% CI [0.62, 2.20], p<0.001), and increased provider ease of IUD insertion (SMD=−1.17, 95% CI [−1.62, −0.73], p<0.001). Fever was statistically significantly higher in dinoprostone versus placebo group (RR=3.73, 95% CI [1.47, 9.44], p=0.006). All other side effects—including nausea, vomiting, shivering, diarrhea, abdominal cramps, vasovagal attack, uterine perforation, and postprocedural bleeding—did not substantially differ between both groups.ConclusionsThis first ever meta-analysis advocates that dinoprostone is safe, effective, and yields favorable analgesic outcomes during IUD insertion.

scholarly journals Effectiveness of Ginger on Pain and Function in Knee Osteoarthritis: A PRISMA Systematic Review and Meta-Analysis

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. E151-E163
Author(s):  
Felipe Araya-Quintanilla
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Knee Function ◽  
Mean Difference ◽  
Eligibility Criteria ◽  
Standard Mean Difference ◽  
And Function

Background: Ginger has been proposed as a complementary treatment for musculoskeletal pain. However, efficacy, type, and safety remains unclear. Objectives: To determine the effectiveness of consumption or topical application of ginger for pain relief and knee function improvement in patients with knee osteoarthritis. Study Design: Systematic review with meta-analysis of randomized clinical trials. Methods: An electronic search was performed on Medline, Central, CINAHL, PEDro, SPORTDiscus, and LILACS databases. The eligibility criteria for selecting studies included clinical trials that compared consumption and/or topical ginger with placebo or other interventions for the pain relief and knee function in patients with medical diagnosis of knee osteoarthritis. Results: Seven clinical trials met the eligibility criteria, and for the quantitative synthesis, 4 studies were included. For the comparison capsules versus placebo, mean difference for pain was −7.88 mm; 95% confidence interval (CI), 11.92 to 3.85 (P = 0.00), and standard mean difference for knee function was −1.61 points; 95% CI, −4.30 to −1.09 (P = 0.24). For the comparison of topical ginger versus standard treatment, standard mean difference for pain was 0.79 mm; 95% CI, −1.97 to 0.39 (P = 0.19), and standard mean difference for knee function was −0.51 points; 95% CI, −1.15 to 0.13 (P = 0.12). Limitations: The current evidence is heterogeneous and has a poor methodologic quality. Conclusions: There is insufficient evidence to support the use of oral ginger compared with placebo in the pain relief and function improvement in patients with knee osteoarthritis. For other comparisons, no statistically significant differences were found. Key words: Osteoarthritis, knee osteoarthritis, ginger, pain, randomized clinical trial, systematic review

scholarly journals Onset of Action and Efficacy of Ibuprofen Liquigel as Compared to Solid Tablets: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 19 (3) ◽  
pp. 301 ◽  
Author(s):  
Hanan Al Lawati ◽  
Fakhreddin Jamali
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Pain Relief ◽  
Comparative Studies ◽  
Analgesic Effect ◽  
Meta Analysis ◽  
Data Bases ◽  
Onset Of Action ◽  
Over The Counter ◽  
Significant Difference

Purpose. Ibuprofen liquigel has been believed to provide faster analgesic effect. However, comparative studies evaluating the efficacy of liquigel versus regular tablets are not available. Hence, we carried out a systematic review and a meta-analysis to compare the onset of action and efficacy of over-the-counter doses of ibuprofen liquigel (IBULG) vs ibuprofen tablets (IBUT).  Methods. Published clinical trials of IBULG and IBUT were identified through a systematic search of various data bases up to October, 2015. Results. In total 18 eligible studies on IBUT and 4 on IBULG were found.  There was no significant difference in the median time to the first perceptible pain relief or the proportion of patients with more than 50% pain relief between the two products. However, IBULG yielded significantly greater odd ratios in meaningful pain relief at 60, 90 and 120 min, but not at 30 min, as compared with IBUT.  Conclusion. The available evidence, although not overwhelming, suggest a faster onset of analgesia for liquigel as compared with tablets. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

scholarly journals Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials

BMJ ◽  
2021 ◽  
pp. n1034 ◽  
Author(s):  
Li Wang ◽  
Patrick J Hong ◽  
Curtis May ◽  
Yasir Rehman ◽  
Yvgeniy Oparin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Clinical Trials ◽  
Pain Relief ◽  
Physical Functioning ◽  
Meta Analysis ◽  
Medical Cannabis ◽  
Increased Risk ◽  
Small Improvement

Abstract Objective To determine the benefits and harms of medical cannabis and cannabinoids for chronic pain. Design Systematic review and meta-analysis. Data sources MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021. Study selection Randomised clinical trials of medical cannabis or cannabinoids versus any non-cannabis control for chronic pain at ≥1 month follow-up. Data extraction and synthesis Paired reviewers independently assessed risk of bias and extracted data. We performed random-effects models meta-analyses and used GRADE to assess the certainty of evidence. Results A total of 32 trials with 5174 adult patients were included, 29 of which compared medical cannabis or cannabinoids with placebo. Medical cannabis was administered orally (n=30) or topically (n=2). Clinical populations included chronic non-cancer pain (n=28) and cancer related pain (n=4). Length of follow-up ranged from 1 to 5.5 months. Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10% (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of −0.50 cm (95% CI −0.75 to −0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of −0.35 cm (−0.55 to −0.14 cm, high certainty)). Medical cannabis taken orally does not improve emotional, role, or social functioning (high certainty). Moderate certainty evidence shows that medical cannabis taken orally probably results in a small increased risk of transient cognitive impairment (RD 2% (0.1% to 6%)), vomiting (RD 3% (0.4% to 6%)), drowsiness (RD 5% (2% to 8%)), impaired attention (RD 3% (1% to 8%)), and nausea (RD 5% (2% to 8%)), but not diarrhoea; while high certainty evidence shows greater increased risk of dizziness (RD 9% (5% to 14%)) for trials with <3 months follow-up versus RD 28% (18% to 43%) for trials with ≥3 months follow-up; interaction test P=0.003; moderate credibility of subgroup effect). Conclusions Moderate to high certainty evidence shows that non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain relief, physical functioning, and sleep quality among patients with chronic pain, along with several transient adverse side effects, compared with placebo. The accompanying BMJ Rapid Recommendation provides contextualised guidance based on this body of evidence. Systematic review registration https://osf.io/3pwn2

scholarly journals Efficacy and Safety of COVID-19 Vaccines: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 467
Author(s):  
Ali Pormohammad ◽  
Mohammad Zarei ◽  
Saied Ghorbani ◽  
Mehdi Mohammadi ◽  
Mohammad Hossein Razizadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Immune Responses ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Receptor Binding Domain ◽  
Efficacy And Safety ◽  
Vectored Vaccine ◽  
Local Side

The current study systematically reviewed, summarized and meta-analyzed the clinical features of the vaccines in clinical trials to provide a better estimate of their efficacy, side effects and immunogenicity. All relevant publications were systematically searched and collected from major databases up to 12 March 2021. A total of 25 RCTs (123 datasets), 58,889 cases that received the COVID-19 vaccine and 46,638 controls who received placebo were included in the meta-analysis. In total, mRNA-based and adenovirus-vectored COVID-19 vaccines had 94.6% (95% CI 0.936–0.954) and 80.2% (95% CI 0.96.4–0.92.7) efficacy in phase II/III RCTs, respectively. Efficacy of the adenovirus-vectored vaccine after the first (97.6%; 95% CI 0.939–0.997) and second (98.2%; 95% CI 0.980–0.984) doses was the highest against receptor-binding domain (RBD) antigen after 3 weeks of injections. The mRNA-based vaccines had the highest level of side effects reported except for diarrhea and arthralgia. Aluminum-adjuvanted vaccines had the lowest systemic and local side effects between vaccines’ adjuvant or without adjuvant, except for injection site redness. The adenovirus-vectored and mRNA-based vaccines for COVID-19 showed the highest efficacy after first and second doses, respectively. The mRNA-based vaccines had higher side effects. Remarkably few experienced extreme adverse effects and all stimulated robust immune responses.

Sign in / Sign up

Export Citation Format

Share Document