The aim of the present meta-analysis was to systematically examine the literature and to identify of the results of randomized controlled trials (RCTs) comparing the efficacy and safety of regional anesthesia (RA) versus general anesthesia (GA) for percutaneous nephrolithotomy (PCNL). An exhaustive electronic literature search of PubMed, Embase, and Web of science was performed until March 2018. Nine prospective RCTs concluding 858 patients comparing the use of RA to GA for PCNL were included. Combined results demonstrated that PCNL under RA could reduce operative time (mean difference [MD] -6.20; 95% CI -10.39 to -2.01), hospital stay (MD -0.59; 95% CI -0.74 to -0.45), visual analgesic score on the first and third postoperative day (MD -2.62, 95% CI -3.04 to -2.19 and MD -0.38; 95% CI -0.58 to -0.18) , analgesic requirements (MD -36.84; 95% CI -55.23 to -18.45), and nausea and/or vomiting (relative risk [RR] 0.28; 95% CI 0.13-0.61). There were no significant differences between RA and GA groups in terms of stone-free rate, blood transfusion, and postoperative fever rate. The results of subgroup analysis were basically consistent with the overall findings. Current evidence suggests that RA is an available and safe option in carefully evaluated and selected patients.
Objective We conducted a systematic literature search and meta-analysis to identify randomized controlled trials (RCTs) comparing the efficacy and safety of ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting (PONV; PON and POV, respectively) in patients undergoing laparoscopic surgery. Methods The electronic databases PubMed, EMBASE, Web of Science, and Cochrane Library were searched up to March 2019 to identify relevant studies. Results The final pooled analysis included 6 RCTs and revealed that postoperative treatment with ramosetron at 24 to 48 hours after surgery significantly reduced the incidence of PON and POV relative to treatment with ondansetron. In a subgroup analysis, ramosetron 0.3 mg tended to reduce PON (0–2 hours) and POV (24–48 hours) more effectively than ondansetron 4 mg. However, no statistical difference was observed between ramosetron 0.3 mg and ondansetron 8 mg in terms of the reduction of PON or POV during any time interval within the first 48 hours after surgery. Conclusions Our results indicate that ramosetron 0.3 mg is superior to ondansetron 4 mg and comparable to ondansetron 8 mg for PONV prophylaxis after laparoscopic surgery.
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