Purpose A systematic review to determine the effectiveness of intra-arterial anaesthetics on post- operative pain and opioid analgesia requirements in arterial embolisation procedures. Materials and methods A systematic review of the literature was performed (Embase, PubMed, MEDLINE and the Cochrane Library) from inception to 10th August 2020. Randomised controlled trials (RCTs) and cohort studies that utilised intra-arterial anaesthesia during an embolisation procedure for the purposes of pain control were included. Eligibility was assessed by two investigators independently. Results Eight hundred fifty-nine candidate articles were identified, and 9 studies met the inclusion criteria (6 RCTs and 3 retrospective cohort studies). Four studies were of hepatic chemoembolisation and 5 were of uterine artery embolisation. Five hundred twenty-nine patients were treated in total. All studies used lidocaine as the anaesthetic with doses ranging from 20 to 200 mg, and the anaesthetic was delivered varyingly before, during or after embolisation. Pain intensity was converted to a numeric scale from 0 to 10, and opioid doses were converted to milligram morphine equivalent doses. A random-effects meta-analysis model was used to analyse the results of RCTs, and the results of cohort studies were summarised with a narrative synthesis. The meta-analyses suggested that pain scores were reduced by a mean of 1.02 (95% CI − 2.34 to 0.30; p = 0.13) and opioid doses were reduced by a mean of 7.35 mg (95% CI, − 14.77, 0.06; p = 0.05) in the intervention group however neither finding was statistically significant. No serious adverse events were reported. Conclusion Intra-arterial anaesthetic may slightly reduce pain intensity and post-operative opioid consumption following embolisation, however the results are not statistically significant. There is very limited data available on the effect of anaesthetic on length of hospital admission. Whilst no serious adverse events were reported, there are some concerns regarding the effect of lidocaine on the technical success of embolisation procedures that preclude our recommendation for routine use in embolisation procedures. High quality randomised controlled trials are required to elucidate the dose-response effect of lidocaine on opioid consumption and pain following embolisation, particularly in the first few hours post-operatively, as well as effects on duration of hospital stay.
The akinetic-rigid (AR) subtype of Parkinson’s disease (PD), characterised by rigidity, akinesia and gait impairment, is associated with cognitive impairment unlike the tremor dominant (TD) subtype. It is unknown which symptoms in AR-PD drive this relationship, and whether individual symptoms are better predictors of cognitive impairment than motor subtype.MethodsUsing a 100 item questionnaire, self-rated symptom severity data on PD-related symptoms sampled when the person signed up to the Parkinson’s UK Tissue Bank. Multivariate regression analysis was used to assess individual symptom scores as predictors of cognitive impairment severity, measured using composite scores of the cognitive symptom questionnaire items.ResultsGait disturbance was the only motor symptom predicting increasing cognitive impairment score (β=0.4025; p=0.0003). Additional significant predictors included: neuropsychiatric symptom score (β=0.2952; p=0.001), anosmia score (β=0.627; p=0.0004) and hallucination score (β=0.7586; p<0.0001).DiscussionGait disturbance, hallucinations, neuropsychiatric symptoms and anosmia are associated with cognitive impairment in PD. Gait disturbance is unique among PD motor symptoms, in its relationship to cognitive impairment. Individual motor symptoms are of greater prognostic value than motor subtypes.
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