Effect of Intraoperative Phrenic Nerve Infiltration on Postoperative Ipsilateral Shoulder Pain After Thoracic Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Hung, Yi-An; Sun, Cheuk‐Kwan; Chiang, Min-Hsien; Chen, Jui-Yi; Ko, Ching-Chung; Chen, Chih‐Chun; Chen, Yu; Teng, I-Chia; Hung, Kuo‐Chuan

doi:10.1053/j.jvca.2022.04.016

Cited by 6 publications

(5 citation statements)

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“…Furthermore, type of surgical approaches was related to the effectiveness of PNI. This was supported by the finding of a previous meta-analysis which demonstrated that PNI could significantly lower the severity of ISP at 6 h in VATS compared to thoracotomies [ 37 ]. As mentioned earlier, type of surgical approaches has an impact on the incidence and severity of ISP as well as the effectiveness of PNB and should be taken into considered during the analysis.…”

Section: Discussionsupporting

confidence: 68%

“…The results of several studies supported PNI being able to significantly reduce the incidence and severity of ISP compared to SNB [ 6 , 21 ] and placebo [ 1 , 5 , 16 , 21 ]. Corresponding to the findings of a recent meta-analysis focusing on the effectiveness of PNI and ISP [ 37 ], PNI significantly decreased the incidence and severity of ISP compared to placebo during 6 and 24 h after thoracotomy, whereas a previous study found that the use of PNI at the level of the azygous vein significantly reduced the severity but not the incidence of ISP compared to placebo during 24 h after VATS [ 33 ]. Some sensory fibers leave the phrenic nerve to supply parietal and mediastinal pleura earlier than the location of PNI leading to inadequate PNB.…”

Section: Discussionmentioning

confidence: 72%

“…The relationship between type of surgical approach and ISP is controversial. A few studies concluded that type of surgical approach was not associated with the incidence of ISP [ 35 , 37 ]. Whereas a previous cohort study reported that the incidence of ISP in thoracotomies patients (58.5%) was higher than VATS (20.9%) and thoracotomy was an independent risk factor of ISP [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

et al. 2023

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Background and Objectives: Ipsilateral shoulder pain (ISP) is a common complication after thoracic surgery. Severe ISP can cause ineffective breathing and impair shoulder mobilization. Both phrenic nerve block (PNB) and suprascapular nerve block (SNB) are anesthetic interventions; however, it remains unclear which intervention is most effective. The purpose of this study was to compare the efficacy and safety of PNB and SNB for the prevention and reduction of the severity of ISP following thoracotomy or video-assisted thoracoscopic surgery. Materials and methods: Studies published in PubMed, Embase, Scopus, Web of Science, Ovid Medline, Google Scholar and the Cochrane Library without language restriction were reviewed from the publication’s inception through 30 September 2022. Randomized controlled trials evaluating the comparative efficacy of PNB and SNB on ISP management were selected. A network meta-analysis was applied to estimate pooled risk ratios (RRs) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results: Of 381 records screened, eight studies were eligible. PNB was shown to significantly lower the risk of ISP during the 24 h period after surgery compared to placebo (RR 0.44, 95% CI 0.34 to 0.58) and SNB (RR 0.43, 95% CI 0.29 to 0.64). PNB significantly reduced the severity of ISP during the 24 h period after thoracic surgery (WMD –1.75, 95% CI –3.47 to –0.04), but these effects of PNB were not statistically significantly different from SNB. When compared to placebo, SNB did not significantly reduce the incidence or severity of ISP during the 24 h period after surgery. Conclusion: This study suggests that PNB ranks first for prevention and reduction of ISP severity during the first 24 h after thoracic surgery. SNB was considered the worst intervention for ISP management. No evidence indicated that PNB was associated with a significant impairment of postoperative ventilatory status.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

et al. 2023

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“…Heterogeneity was assessed with I 2 statistics [i.e., low ( I 2 < 50%), moderate ( I 2 = 50–75%), and high ( I 2 > 75%)]. For studies with a high heterogeneity ( I 2 > 50%), a leave-one-out sensitivity analysis was conducted to evaluate stability of results ( 22 ). A probability value of <0.05 was considered statistically significant for all (including subgroup) analyses.…”

Section: Methodsmentioning

confidence: 99%

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

et al. 2022

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BackgroundThis study aimed at comparing the difference in prognostic outcomes between patients receiving general anesthesia (GA) and conscious sedation (CS) for endovascular thrombectomy after acute ischemic stroke.MethodsDatabases from Medline, Embase, Google scholar, and Cochrane library were searched for randomized controlled studies (RCTs) comparing patients undergoing GA and CS for endovascular thrombectomy following anterior circulation ischemic stroke. The primary outcome was frequency of 90-day good functional outcome [defined as modified Rankin Scale score of ≤ 2], while secondary outcomes included successful recanalization rate (SRR) [i.e., modified thrombolysis in cerebral infarction = 2b or 3], mortality risk, symptomatic intracranial hemorrhage (ICH), procedure-related complications, hypotension, pneumonia, neurological outcome at post-procedure 24–48 h, and puncture-to-recanalization time.ResultsSix RCTs including 883 patients published between 2016 and 2022 were included. Merged results revealed a higher SRR [risk ratio (RR) = 1.11, 95% CI: 1.03–1.2, p = 0.007; I2 = 29%] and favorable neurological outcomes at 3-months (RR = 1.2, 95% CI: 1.01–1.41, p = 0.04; I2 = 8%) in the GA group compared to CS group, without difference in the risk of mortality (RR = 0.88), symptomatic ICH (RR = 0.91), procedure-related complications (RR = 1.05), and pneumonia (RR = 1.9) as well as post-procedure neurological outcome (MD = −0.21) and successful recanalization time (MD = 3.33 min). However, GA was associated with a higher risk of hypotension compared with that of CS.ConclusionPatients with acute anterior circulation ischemic stroke receiving GA were associated with a higher successful recanalization rate as well as a better 3-month neurological outcome compared to the use of CS. Further investigations are warranted to verify our findings.Systematic review registrationwww.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342483, identifier: CRD42022342483.

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“…[27] Sensitivity analysis was performed through removing 1 study each time to evaluate the reliability and robustness of the obtained evidence. [28] For a outcome described in 10 or more studies, the possibility of publication bias was examined by the inspection of a funnel plot and the results of Egger tests. [29] We conducted all statistical analyses with the comprehensive meta-analysis V3 software (Biostat, Englewood, NJ).…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Efficacy of blood urea nitrogen-to-albumin ratio for predicting prognostic outcomes of inpatients with COVID-19: A meta-analysis

Hung

Huang

et al. 2023

Medicine

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Background: The associations between blood urea nitrogen (BUN)/albumin ratio and poor prognosis in patients with diagnosis of coronavirus disease 2019 (COVID-19) remain to be clarified.Methods: A search based on 4 electronic databases (i.e., EMBASE, Google scholar, MEDLINE, and Cochrane Library) was performed on June 23, 2022. The association of BUN/Albumin ratio with poor prognostic outcomes, defined as patients with mortality/severe illnesses, were analyzed.Results: Results from analysis of 7 cohort studies (3600 individuals with COVID-19) published between 2020 and 2022 showed a higher BUN/Albumin ratio in the poor-prognosis group (Mean difference: = 2.838, 95% confidence interval: 2.015-3.66, P < .001, I 2 = 92.5%) than the good-prognosis group. Additional investigation into the connection between BUN/Albumin ratio as a binary variable (i.e., high or low) and the risk of poor outcome also supported an association between a higher BUN/Albumin ratio and a poor prognostic risk (odd ratio = 3.009, 95% confidence interval: 1.565-5.783, P = .001, I 2 = 93.7%, 5 studies). Merged analysis of poor prognosis produced a sensitivity of 0.76, specificity of 0.72, and area under curve of 0.81. Conclusion:This meta-analysis demonstrated a positive correlation between BUN/albumin ratio and poor outcome in patients with COVID-19. Additional large-scale prospective studies are needed to verify our findings.Abbreviations: AUC = area under curve, BUN = blood urea nitrogen, CI = confidence interval, COVID-19 = coronavirus disease 2019, OR = odds ratio, sROC = summary receiver operating characteristic.

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Effect of Intraoperative Phrenic Nerve Infiltration on Postoperative Ipsilateral Shoulder Pain After Thoracic Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Cited by 6 publications

References 30 publications

Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

Efficacy of Phrenic Nerve Block and Suprascapular Nerve Block in Amelioration of Ipsilateral Shoulder Pain after Thoracic Surgery: A Systematic Review and Network Meta-Analysis

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

Efficacy of blood urea nitrogen-to-albumin ratio for predicting prognostic outcomes of inpatients with COVID-19: A meta-analysis

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