Background:The argument on whether extracorporeal shock-wave therapy (ESWT) and corticosteroid injections (CSIs) exert an equivalent pain control or which is the better treatment for plantar fasciitis (PF) in adults remains to be resolved. It is important and necessary to conduct a meta-analysis to make a relatively more credible and overall assessment about which treatment method performs better pain control in treatment of PF in adults.Methods:From the inception to July 2018, the Embase, PubMed, Web of Science, and Cochrane Library electronic databases were searched for all relevant studies. Only randomized controlled trials (RCTs) focusing on comparing ESWT and CSI therapies in PF cases in adults were included. The primary outcome measure was visual analog scale (VAS) reduction, whereas the secondary outcomes included treatment success rate, recurrence rate, function scores, and adverse events.Results:Nine RCTs involving 658 cases were included in this meta-analysis. In the present study, meta-analysis showed that high-intensity ESWT had superior pain relief and success rates relative to the CSI group within 3 months, but the ESWT with low intensity was slightly inferior to CSI for efficacy within 3 months. In addition, patients with CSI may tend to increase the need for the analgesic and more adverse events may be associated with the ESWT. However, the ESWT and CSI present similar recurrent rate and functional outcomes.Conclusion:Our analysis showed that the pain relief and success rates were related to energy intensity levels, with the high-intensity ESWT had the highest probability of being the best treatment within 3 months, followed by CSI, and low-intensity ESWT. More high-quality RCTs with long-term follow-up time are needed to further compare the differences of CSI and ESWT for adults with PF.

ObjectiveControversy still exists regarding the efficiency and safety of liposomal bupivacaine (LB) vs interscalene nerve block (INB) for pain management after total shoulder arthroplasty (TSA). The aim of the present meta-analysis was to perform a relatively credible and overall assessment to compare the efficiency and safety of LB-based infiltration vs INB for pain management after TSA.MethodsThe PubMed, Cochrane Library, Web of Science, and EMBASE were systematically searched. Only studies published up to March 2018 comparing LB vs INB for pain control after TSA were included. The primary outcome extracted from the studies was postoperative pain score at different periods. The secondary outcomes included total opioid consumption, length of hospital stay, and complications.ResultsSeven studies with 707 patients were included in this study. No statistically significant difference was observed between the LB and INB groups in pain scores at 8 hours, 12 hours, 24 hours, postoperative day (POD) 1, and POD 2. The two groups also showed comparable total opioid consumption at POD 0, POD 1, POD 2, and length of hospital stay. The LB group had a significantly higher pain score at 4 hours (standard mean difference =0.65, 95% CI=0.07 to 1.24, P=0.03) but a lower occurrence rate of complications than did the INB group (OR =0.51, 95% CI=0.28 to 0.91, P=0.02).ConclusionThis meta-analysis revealed that INB provides excellent analgesic effects within 4 hours after TSA, while patients treated with LB infiltration experienced significantly less occurrence rate of complications after TSA. In general, both approaches provide similar overall pain relief and have similar opioid consumption after TSA, with no significant difference in the length of hospital stay. Nevertheless, more high-quality randomized controlled trails with long-term follow-up are still required to make the final conclusion.

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