(Anesth Analg. 2017;124(5):1571–1580) Epidural analgesia may slightly prolong the second stage of labor and increase the instrumental birth rate, especially when high concentrations of local anesthetics are used. Consequently, low concentrations of local anesthetics (LCLAs) have become popular for epidural labor analgesia to help mediate second stage labor. The authors of the present study conducted a systematic review and meta-analysis to compare the effects of epidural analgesia with LCLAs with that of nonepidural analgesia on obstetric outcomes.

Background:There is no consensus regarding the therapeutic effect of nasointestinal tubes (NITs) versus nasogastric tubes (NGTs) in the management of small-bowel obstruction (SBO). This study aimed to compare the clinical outcomes between the use of NITs and NGTs in the management of SBO.Methods:Published studies on comparing NITs with NGTs in the treatment of SBO were searched from electronic databases. Two investigators independently extracted the data; any discrepancies were adjudicated by a third investigator. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using Review Manager 5.0.Results:An extensive literature search identified 268 relevant publications, 4 of which met the inclusion criteria. There were no significant differences in the nonrequirement of operative intervention between NITs and NGTs groups (OR: 1.79; 95% CI: 0.55, 5.84). Compared with the NGTs, the NITs, which successfully passed through the pylorus, did not decrease the rate of operation in patients with SBO (OR: 2.19; 95% CI: 0.59, 8.15). There was no advantage of NITs over NGTs in patients with partial SBO (P-SBO) (OR: 1.04; 95% CI: 0.23, 4.60). Postoperative complications were compared between the groups (OR: 2.13; 95% CI: 1.09, 4.15).Conclusion:The result of this meta-analysis showed no advantage of NITs over NGTs in the management of patients with SBO.