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Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta-analysis of randomised controlled trials

The objective of the study was to assess the efficacy and safety of mepivacaine compared with lidocaine used in local anaesthesia in dentistry. Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure and WHO International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand-searched for randomised controlled trials comparing mepivacaine with lidocaine in terms of efficacy and safety. Twenty-eight studies were included, of which 15 had low risk of bias and 13 had moderate risk of bias. In comparison with 2% lidocaine with 1:100,000 adrenaline, 3% mepivacaine showed a lower success rate (P = 0.05), a shorter onset time of pulpal anaesthesia (P = 0.0005), inferior pain control during injection phase and superior inhibition of heart rate increase (P < 0.0001). In contrast, 2% mepivacaine with 1:100,000 adrenaline gave a higher success rate (P < 0.00001), a similar onset time of pulpal anaesthesia (P = 0.34) and superior pain control during injection phase (P < 0.0001); 2% mepivacaine with 1:20,000 levonordefrin had the same success rate (P = 0.69) and similar onset time of pulpal anaesthesia (P = 0.90). In addition, 3% mepivacaine had shorter onset time (P = 0.004), same level of success rate (P = 0.28) and similar pain control during injection and postinjection compared with 2% lidocaine with 1:50,000 adrenaline. Given the efficacy and safety of the two solutions, 2% mepivacaine with vasoconstrictors is better than 2% lidocaine with vasoconstrictors in dental treatment. Meanwhile, 3% plain mepivacaine is better for patients with cardiac diseases.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Sedation and Anesthesia Options for Diagnostic Procedures: A Review of Clinical Effectiveness and Guidelines [Internet]

The purpose of this rapid review was to assess the available evidence regarding the clinical effectiveness of sedation and/or anesthesia options in patients undergoing diagnostic procedures who are required to be still. Furthermore, guidelines on sedation and anesthesia in patients undergoing diagnostic procedures were identified and assessed.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 8, 2015
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Pain Management Interventions for Hip Fracture [Internet]

To review and synthesize the evidence on pain management interventions in nonpathological hip fracture patients following low-energy trauma. Outcomes include pain management (short and long term), mortality, functional status, pain medication use, mental status, health-related quality of life, quality of sleep, ability to participate in rehabilitation, return to pre-fracture living arrangements, health services utilization, and adverse effects.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: May 2011
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Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials

The authors concluded that adding clonidine to intrathecal local anaesthetic had beneficial effects on some, but not all measures of motor and sensory block. Adding clonidine reduced intra-operative pain but increased the risk of arterial hypotension. Given the low quality of the included studies and the possibility of publication bias, the reliability of the results is questionable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Temporary pain in the lower extremities following spinal anaesthesia with lidocaine compared to other local anaesthetics

Lidocaine is the drug of choice for inducing spinal anaesthesia in ambulatory surgery because of its rapid onset of action, intense nerve blockade, and short duration of action. The possible side effects of spinal anaesthesia in adults, which develop after recovery, are backache, post‐dural puncture headache, and transient neurologic symptoms that are characterized by slight to severe pain in the buttocks and legs. TNS symptoms develop within a few hours and up to 24 hours after anaesthesia. They last, in most cases, up to two days. The present review shows that lidocaine is more likely to cause transient neurologic symptoms than bupivacaine, prilocaine, and procaine. However, these drugs produce prolonged local anaesthetic effects and therefore are not desirable for ambulatory patients. It is possible that the reintroduction of 2‐chloroprocaine will solve this lack of a suitable intrathecal local anaesthetic; confirmatory studies are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

The Clinical Effectiveness and Cost-Effectiveness of Management Strategies for Sciatica: Systematic Review and Economic Model

Sciatica is a symptom characterised by well-localised leg pain with a sharp, shooting or burning quality that radiates down the back of the leg and normally to the foot or ankle. It is often associated with numbness or altered sensation in the leg.

Health Technology Assessment - NIHR Journals Library.

Version: November 2011
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The diagnostic utility and cost-effectiveness of selective nerve root blocks in patients considered for lumbar decompression surgery: a systematic review and economic model

Study found few studies that estimated the diagnostic accuracy of selective nerve root blocks (SNRBs) in patients with radiculopathy and all were limited by the difficulty of making a reference standard diagnosis. Based on current weak evidence, it is unlikely that SNRB is a cost-effective method for identifying the symptomatic nerve root prior to lumbar spine surgery.

Health Technology Assessment - NIHR Journals Library.

Version: May 2013
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Pain Management Injection Therapies for Low Back Pain [Internet]

Low back pain is common and injections with corticosteroids are a frequently used treatment option. This report reviews the current evidence on effectiveness and harms of epidural, facet joint, and sacroiliac corticosteroid injections for low back pain conditions.

Technology Assessment Report - Agency for Healthcare Research and Quality (US).

Version: 2015
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Low Back Pain and Sciatica in Over 16s: Assessment and Management

This guideline covers the assessment and management of low back pain and sciatica in adults over the age of 16 years.

NICE Guideline - National Guideline Centre (UK).

Version: November 2016
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Postnatal Care: Routine Postnatal Care of Women and Their Babies [Internet]

This guideline has been written within a conceptual framework which places the woman and her baby at the centre of care, appreciating that all postnatal care should be delivered in partnership with the woman and should be individualised to meet the needs of each mother-infant dyad. The guideline aims to identify the essential ‘core care’ which every woman and her baby should receive, as appropriate to their needs, during the first 6–8 weeks after birth, based upon the best evidence available.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: July 2006
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Parenteral treatment of episodic tension-type headache: a systematic review

BACKGROUND: Tension-type headache is highly prevalent in the general population and is a consistent if not frequent cause of visits to acute care settings. Analgesics such as nonsteroidal anti-inflammatory drugs, acetaminophen, and salicylates are considered first-line therapy for treatment of tension-type headache. For patients who present to an acute care setting with persistent tension-type headache despite analgesic therapy, it is not clear which parenteral agent should be administered. We performed a systematic review of the medical literature to determine whether parenteral therapies other than salicylates or nonsteroidals are efficacious for acute tension-type headache.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Effects of preemptive epidural analgesia on post-thoracotomy pain

The authors concluded that preemptive thoracic epidural analgesia (TEA) appeared to reduce the severity of acute post-operative pain compared with TEA initiated after completion of surgery for patients undergoing unilateral thoracotomy, but did not affect the incidence of chronic post-thoracotomy pain. Overall, the review was well-conducted and the authors' cautious conclusions appear appropriate.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis

This review concluded that paracervical local anaesthetic injection was the best method of pain control for women who undergo hysteroscopy as out-patients. The authors' conclusion reflected the evidence available. However, given the limitations of the review and available evidence, the conclusions appear overly strong in favour of the one method.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Should we add clonidine to local anesthetic for peripheral nerve blockade: a qualitative systematic review of the literature

Clonidine improved the duration of analgesia and anaesthesia when used as an adjunct to intermediate-acting local anaesthetics for some peripheral nerve blocks. The authors' conclusions reflected the evidence presented, but in light of both a lack of reporting, and the presence of several methodological concerns with the review, the authors' conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Efficacy and safety of clonidine as additive for caudal regional anesthesia: a quantitative systematic review of randomized controlled trials

The review concluded that, compared to caudal local anaesthetics alone, caudally administered clonidine in addition to local anaesthetics provided extended duration of analgesia with a decreased incidence for analgesic rescue requirement and few adverse events. The review was generally well conducted but, due to substantial heterogeneity and potential publication bias, the authors' conclusions should be considered tentative.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials

The authors concluded that adding clonidine to intermediate or long-acting local anaesthetics for single-shot peripheral nerve or plexus blocks prolonged duration of analgesia and motor block, but increased hypotension, fainting and sedation. There were some limitations in the review, but overall evidence appeared to support the authors’ conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials

This well-conducted review concluded that an anaesthetic regimen including thoracic epidural analgesia did not reduce mortality or myocardial infarction after cardiac surgery; there was evidence of reductions in renal impairment, duration of postoperative ventilation and the composite endpoint of death/myocardial infarction. Overall, as most data came from small lower quality trials, the authors' conclusions should be treated with some caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The effect of stimulating versus nonstimulating catheter techniques for continuous regional anesthesia: a semiquantitative systematic review

This review found that stimulating catheters were associated with superior regional anaesthesia compared with non-stimulating catheters. Potential methodological flaws in the review and the unknown quality of the included trials mean that the authors' conclusions should be interpreted with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Continuous peripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials

The review concluded that compared with single-injection, continuous peripheral nerve block was associated with improved pain control and satisfaction, reduced opioid use, and less nausea in patients undergoing surgery. The authors’ conclusions were based on the evidence and seem reasonable, although the high levels of variation and quality issues should be considered when interpreting the evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials

This generally well-conducted review concluded that there was no benefit of epidural analgesia on mortality or length of intensive care unit stay and hospital stay, but there may be a reduced duration of mechanical ventilation with thoracic epidural analgesia with local anaesthetics. The conclusion appears likely to be reliable, but is based on small studies of variable quality.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

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