Intrathecal Anesthesia and Recovery from Radical Prostatectomy

Brown, Daniel R.; Hofer, Roger E.; Patterson, David E.; Fronapfel, Paul J.; Maxson, Pamela M.; Narr, Bradly J.; Eisenach, John H.; Blute, Michael L.; Schroeder, Darrell R.; Warner, David O.

doi:10.1097/00000542-200404000-00024

Cited by 36 publications

(70 citation statements)

References 12 publications

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“…Brown et al 16 reported that one patient who presented bradycardia was withdrawn from the study to investigate myocardial infarction, which was not confirmed at the end of the study. The data from Shir et al 19 and…”

Section: Discussionmentioning

confidence: 94%

“…[11][12][13][14][15][16][17][18][19][20][21] Pooling the results to produce a meta-analysis was not possible. The decision not to perform a meta-analysis took into account the fact that the interventions and outcomes assessed were different among the RCTs included.…”

Section: Discussionmentioning

confidence: 99%

“…Brown et al 16 reported data correctly; Dauri et al 17 reported patients for renal transplantation; and the data from Shir et al 19 and…”

Section: Length Of Hospitalizationmentioning

confidence: 97%

“…The analysis on study validity demonstrated the following: one of these 10 RCTs presented a Jadad score greater than three; 16 two…”

Section: Study Validitymentioning

confidence: 99%

“…RCTs had more than five "yes" answers in the Delphi list analysis; 13,16 the allocation concealment was described correctly in four RCTs; 11,13,14,16 the sequence generation method was not described in seven RCTs; 11,12,15,17,[19][20][21] and blinding was not described in eight RCTs. [11][12][13][14][15]17,19,21 One study was described as single-blind.…”

Section: Study Validitymentioning

confidence: 99%

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Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review

Barbosa

Castro

2013

Sao Paulo Med. J.

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CONTEXT AND OBJECTIVE: Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial. SciELO and EMBASE (1974 to October 2012). The reference lists of the studies included and of one systematic review in the same field were also analyzed. The studies included were randomized controlled trials (RCT) that analyzed neuraxial anesthesia and general anesthesia for urological surgery. RESULTS:The titles and abstracts of 2720 articles were analyzed. Among these, 16 studies were identified and 11 fulfilled the inclusion criteria. One RCT was published twice. The study validity was: Jadad score > 3 in one RCT; seven RCTs with unclear risk of bias as the most common response; and five RCTs not fulfilling half of the Delphi list items. The frequency of mortality was not significant between study groups in three RCTs. Meta-analysis was not performed. CONCLUSION: At the moment, the evidence available cannot prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery. There were insufficient data to pool the results relating to mortality, stroke, myocardial infarction, length of hospitalization, quality of life, degree of satisfaction, postoperative cognitive dysfunction and blood transfusion requirements. RESUMO CONTEXTO E OBJETIVO:A escolha da melhor técnica anestésica para cirurgias urológicas para reduzir mortalidade permanece controversa. O objetivo foi comparar a efetividade e segurança da anestesia neuroaxial versus anestesia geral para cirurgias urológicas.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

“…Brown et al 16 reported data correctly; Dauri et al 17 reported patients for renal transplantation; and the data from Shir et al 19 and…”

Section: Length Of Hospitalizationmentioning

confidence: 97%

“…The analysis on study validity demonstrated the following: one of these 10 RCTs presented a Jadad score greater than three; 16 two…”

Section: Study Validitymentioning

confidence: 99%

Section: Study Validitymentioning

confidence: 99%

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Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review

Barbosa

Castro

2013

Sao Paulo Med. J.

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Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

Andreae

2012

Cochrane Database of Systematic Reviews

101

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Background Regional anaesthesia may reduce the rate of persistent (chronic) pain after surgery, a frequent and debilitating condition. Objectives To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), PubMed (1966 to April 2012), EMBASE (1966 to May 2012) and CINAHL (1966 to May 2012) without any language restriction. We used a combination of free text search and controlled vocabulary search. The results were limited to randomized controlled clinical trials (RCTs). We conducted a handsearch in reference lists of included trials, review articles and conference abstracts. Selection criteria We included RCTs comparing local anaesthetics or regional anaesthesia versus conventional analgesia with a pain outcome at six or 12 months after surgery. Data collection and analysis Two authors independently assessed trial quality and extracted data, including information on adverse events. We contacted study authors for additional information. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects models (inverse variance method). We grouped studies according to surgical interventions. We employed the Chi2 test and calculated the I2 statistic to investigate study heterogeneity. Main results We identified 23 RCTs studying local anaesthetics or regional anaesthesia for the prevention of persistent (chronic) pain after surgery. Data from a total of 1090 patients with outcomes at six months and of 441 patients with outcomes at 12 months were presented. No study included children. We pooled data from 250 participants after thoracotomy, with outcomes at six months. Data favoured regional anaesthesia for the prevention of chronic pain at six months after thoracotomy with an OR of 0.33 (95% CI 0.20 to 0.56). We pooled two studies on paravertebral block for breast cancer surgery; the pooled data of 89 participants with outcomes at five to six months favoured paravertebral block with an OR of 0.37 (95% CI 0.14 to 0.94).The methodological quality of the included studies was intermediate. Adverse effects were not studied systematically and were reported sparsely. Clinical heterogeneity, attrition and sparse outcome data hampered the assessment of effects, especially at 12 months. Authors’ conclusions Epidural anaesthesia may reduce the risk of developing chronic pain after thoracotomy in about one patient out of every four patients treated. Paravertebral block may reduce the risk of chronic pain after breast cancer surgery in about one out of every five women treated. Our conclusions are significantly weakened by performance bias, shortcomings in allocation concealment, considerable attrition and incomplete outcome data. We caution that our evidence synthesis is based on only a few, small studies. More studies with high methodological quality, addre...

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Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

Weinstein

Levene

Cohen

et al. 2018

Cochrane Database of Systematic Reviews

121

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We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, null bias, attrition and missing data. Larger, high-quality studies, including children, are needed. We caution that except for breast surgery, our evidence synthesis is based on only a few small studies. On a cautionary note, we cannot extend our conclusions to other surgical interventions or regional anaesthesia techniques, for example we cannot conclude that paravertebral block reduces the risk of PPP after thoracotomy. There are seven ongoing studies and 12 studies awaiting classification that may change the conclusions of the current review once they are published and incorporated.

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Intrathecal Anesthesia and Recovery from Radical Prostatectomy

Cited by 36 publications

References 12 publications

Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review

Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review

Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

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