1.
General Anesthesia Versus Regional Anesthesia in the Elderly Patients Undergoing Hip Fracture Surgeries: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Cao, M. M., Zhang, Y. W., Sheng, R. W., Gao, W., Kang, Q. R., Gao, Y. C., Qiu, X. D., Rui, Y. F.
World Journal of Surgery. 2023
Abstract
BACKGROUND Surgery is the preferred treatment option for the elderly patients with hip fractures. However, the choice of general anesthesia (GA) or regional anesthesia (RA) remains controversial. The quality of evidence has further improved with the advent of several high-quality randomized clinical trials (RCTs) in the last two years. The purpose of this study was to compare the clinical outcomes of two anesthetic techniques in elderly patients undergoing hip fracture surgeries. METHODS Eligible studies were identified from PubMed/MEDLINE, Web of Science, Scopus, EMBASE and reference lists from January 2000 to June 2022 in this current systematic review and meta-analysis. The outcomes included the surgery-related outcomes (duration of surgery, duration of anesthesia, intraoperative blood loss and number of transfusions) and postoperative outcomes (30-day mortality, postoperative delirium,cardiovascular events and other complications). RESULTS A total of 10 RCTs were included, and a total of 3594 patients were analyzed. RA was associated with shorter duration of surgery, shorter length of hospital stays and less intraoperative blood loss compared to GA. There were no significant differences between the two groups in the number of blood transfusions, duration of anesthesia, 30-day mortality or postoperative delirium. CONCLUSIONS Our pooled analysis identified no significant differences in terms of the safety between RA and GA, while RA reduces intraoperative blood loss, length of hospital stays and duration of surgery. These results suggest that RA appears to be preferable for the elderly patients with hip fractures.
2.
To Investigate the Effect of Glucocorticoids on Blood Loss during and after First Total Hip Arthroplasty and Its Safety Meta-Analysis
Wang C, Li F, Liu W, Huang W, Li Q, Yin D
Journal of healthcare engineering. 2021;2021:9681129
Abstract
OBJECTIVE To evaluate the efficacy and safety of topical glucocorticoids for total hip arthroplasty by meta-analysis. METHODS A computerized search of the Cochrane Library, MEDLINE, EMBASE, and PubMed English databases, as well as Chinese Biomedical Literature Database, vipu Chinese Science and Technology Journal Database, Wanfang database, and Chinese Knowledge Net Database, was performed to include all randomized controlled trials (RCTs) regarding topical glucocorticoid therapy for postoperative bleeding after THA according to the inclusion criteria. The quality evaluation criteria of RCTs, as stated in the Cochrane Handbook for Systematic Reviews of Interventions 4.2.5, were adopted for evaluation, and the meta-analysis was performed using RevMan 5.3. RESULTS A total of 10 articles were included, including 1,112 patients: 566 in the topical glucocorticoid group and 546 in the control group. The transfusion rate was 8.43% for topical glucocorticoids and 30.05% for the control group (P < 0.001), and topical glucocorticoids reduced 317.89 ml total blood loss and 76.82 ml invisible blood loss, with statistically significant differences (P < 0.001). The amount of intraoperative blood loss was reduced by topical glucocorticoids, but the difference was not statistically significant (P=0.83), and the postoperative HB value was increased by topical glucocorticoids, although the difference was statistically significant (P < 0.001). The incidence of DVT and PE after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%), the difference was not statistically significant (P=0.54), and the incidence of infection after topical glucocorticoid application (3.03%) was greater than that of the control group (2.40%). The difference was not statistically significant (P=0.39). CONCLUSIONS Topical glucocorticoids can reduce the transfusion rate and blood loss in THA patients without increasing their risk of thrombosis.
3.
The efficacy and safety of epinephrine for postoperative bleeding in total joint arthroplasty: A PRISMA-compliant meta-analysis
Teng Y, Ma J, Ma X, Wang Y, Lu B, Guo C
Medicine. 2017;96((17)):e6763.
Abstract
BACKGROUND Total joint arthroplasty (TJA) usually results in postoperative bleeding. Some randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs) have been performed to evaluate the effects of epinephrine on postoperative bleeding after TJA. However, this remained controversial about the efficacy and safety of epinephrine for postoperative bleeding in TJA. The objective of our meta-analysis was to compare the overall effect and safety of epinephrine and placebo for postoperative bleeding in TJA. METHODS PubMed, Embase, and the Cochrane Library were searched to identify potentially relevant articles. RCTs or non-RCTs involving epinephrine and placebo for blood loss in total knee arthroplasty or total hip arthroplasty were included. Our study was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RevMan v5.3 was used to analyze the relevant data. RESULTS Four RCTs and 1 non-RCT involving 646 participants met the inclusion criteria. The overall pooled results from meta-analysis demonstrated that compared with control groups, epinephrine groups could significantly reduce the postoperative bleeding volume (mean difference [MD] = -168.42, 95% confidence interval [CI]: -272.37 to -64.47, P = 0.001). There was no significant difference in intraoperative bleeding volume between epinephrine and control groups (MD = -12.89, 95% CI: -53.45 to 27.69, P = 0.53). No significant difference was found between 2 groups in terms of postoperative hemoglobin loss (MD = -0.28, 95% CI: -0.66 to 0.10, P = 0.15). Compared with the control groups, no statistically significant difference was found in terms of postoperative transfusion rate in epinephrine groups (relative risk [RR] 0.86, 95% CI: 0.64-1.15, P = 0.31). In addition, the results of the meta-analysis also indicated no significant difference in terms of the incidence rate of deep venous thrombosis (DVT) between 2 groups (RR 0.28, 95% CI: 0.05-1.64, P = 0.16). CONCLUSION The meta-analysis showed that epinephrine could significantly reduce postoperative bleeding volume in TJA without increasing the incidence of DVT. However, there was no significant reduction in intraoperative bleeding volume, postoperative hemoglobin loss, and transfusion rate after the administration of epinephrine. LIMITATIONS In this study, a higher heterogeneity and a risk of selection bias may be present in postoperative hemoglobin loss. In addition, the sample size of the included studies was too small, so our findings need to be further validated with more high-quality and larger scale RCTs in the future. SYSTEMATIC REVIEW REGISTRATION NUMBER None.