This study aimed to investigate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) in postoperative acute pain control. PubMed, Scopus, and Cochrane Library were searched on 1–8 December 2022, for randomized controlled trials on the analgesic effects of TENS. The outcomes were pain intensity and opioid use (primary), and postoperative (PO) adverse events, blood pressure, and the duration of hospital stay (secondary); PROSPERO CRD42022333335. A total of 40 articles were included in the meta-analysis. Pain intensity at rest and during coughing for all types of surgeries combined was lower in the TENS group (standardized mean difference (SMD) = −0.51 [−0.61, −0.41], p < 0.00001, 29 studies, and −1.28 [−2.46, −0.09], p-value = 0.03, six studies, respectively). There was a statistically significant decrease in morphine requirements, as well as in the incidence of postoperative nausea and vomiting, dizziness, and pruritus. There was no difference between the groups in postoperative pain intensity during walking, in blood pressure, and only a borderline difference in the length of hospital stay. The subgroup analysis by surgery type did not show significant differences between the groups in pain severity at rest. Thus, TENS has a potential for pain control and postoperative recovery outcomes.

Background: Perioperative disorders of neurocognitive function are a set of heterogeneous conditions, which include transient post-operative delirium (POD) and more prolonged post-operative cognitive dysfunction (POCD). Since the number of annually performed surgical procedures is growing, we should identify which type of anesthesia is safer for preserving neurocognitive function. The purpose of this study was to compare the effect of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing surgical procedures under general anesthesia and regional anesthesia. Material and methods: We searched for randomized controlled studies, which studied post-operative cognitive outcomes after general and regional anesthesia in the adult patient population. Results: Thirteen articles with 3633 patients: the RA group consisted of 1823 patients, and the GA group of 1810 patients, who were selected for meta-analysis. The overall effect of the model shows no difference between these two groups in terms of risk for post-operative delirium. The result is insensitive to the exclusion of any study. There was no difference between RA and GA in terms of post-operative cognitive dysfunction. Conclusions: There was no statistically significant difference between GA and RA in the incidence of POD. There was no statistically significant difference in the incidence of POCD per-protocol analysis, psychomotor/attention tests (preoperative/baseline, post-operative), memory tests (postoperatively, follow up), mini-mental state examination score 24 h postoperatively, post-operative reaction time three months postoperatively, controlled oral word association test, and digit copying test. There were no differences in the incidence of POCD in general and regional anesthesia at one week postoperatively, three months postoperatively, or total events (one week or three months). The incidence of post-operative mortality also did not differ between two groups.

Background: Neurocognitive alterations in the perioperative period might be caused by a wide variety of factors including pain, blood loss, hypotension, hypoxia, micro- and macroemboli, cardiopulmonary bypass (CPB), reperfusion damage, and surgery itself, and all are risk factors for developing postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). The objective of this study was to evaluate the effect of ketamine on neurocognitive dysfunction after anesthesia. Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing ketamine use (experimental group) with placebo (controls). Results: The model favors the control group over the experimental group in terms of frequency of hallucinations (the risk ratio with 95% CI is 1.54 [1.09, 2.19], p-value = 0.02), the number of patients readmitted within 30 days (RR with 95% CI is 0.25 [0.09, 0.70]), and the number of adverse events (overall RR with 95% CI is 1.31 [1.06, 1.62]). In terms of morphine consumption, the model favors the experimental group. Conclusion: There was no statistically significant difference in incidences of postoperative delirium, vasopressor requirement, and fentanyl consumption between the ketamine and control groups. However, hallucinations were more frequently reported in the ketamine group.

Background/Objectives: Due to post-surgical discomfort in kidney transplant recipients and donors as well as opioids’ multiple side effects, alternative analgesic methods are required in renal transplant surgeries. This study aimed to evaluate the analgesic effect of the transversus abdominis plane (TAP) block versus no-block controls in kidney transplantation patients. Methods: We conducted a meta-analysis with a trial sequential analysis (TSA) of randomized controlled trials (RCTs). We searched for relevant articles in PubMed, Scopus, and the Cochrane Library published before December 2023. Protocol registration: doi.org/10.17605/OSF.IO/PMZJ4. Results: A total of 11 RCTs were included in the meta-analysis. The TAP block group had lower pain intensity on postoperative day 1 (mean difference, MD = −0.65 [−0.88, −0.42]; p < 0.00001) than the control group. However, the heterogeneity among the included studies was considerable (I² = 93%). Subgroup meta-analysis and TSA revealed a significant pain reduction at 24 h postoperatively in donors (MD = −0.70 [−1.16, −0.24]; p = 0.003); heterogeneity was substantial (I² = 67%). The TAP block group also had lower overall morphine consumption within 24 h (MD = −4.82 [−7.87, −1.77]; p = 0.002) and cumulative 24 h morphine use (MD = −14.13 [−23.64, −4.63]; p = 0.004); however, heterogeneity was considerable (I² = 98% in both cases). The time to first analgesia (hours) was significantly longer in the TAP block group (MD = 5.92 h [3.63, 8.22]; p < 0.00001, n = 3). There was no significant difference between the groups in postoperative nausea and vomiting (risk ratio, RR = 0.91 [0.49, 1.71]; p = 0.78). Conclusions: TAP block can lower pain intensity and reduce morphine consumption on the first postoperative day in patients undergoing renal transplantation. Pain reduction is especially notable in the subgroup of donors, but the benefits reported are minimum and certainly not clinically relevant. Larger, well-powered RCTs are warranted to confirm these results and evaluate the effect of TAP block in the subgroup of recipients.

Aim: To study the effect of epidural dexamethasone in postoperative pain management. Methods: Random-effects meta-analysis was conducted in RevMan 5.4. Results: We included nine randomized-controll... Plain language summary Pain after major surgeries can be severe. Sometimes patients need to take additional analgesics after surgery. Dexamethasone is a steroid, which can potentially reduce this p... Tweetable abstract Meta-analysis of nine RCTs with 657 patients showed that dexamethasone reduces the incidence of postoperative nausea and vomiting, but not postoperative pain or length of hospita...

Surgical interventions in hip fracture have been associated with multiple adverse events, including perioperative hypotension and mortality, making the choice of the anesthetic method for this procedure crucial. There is still no consensus on whether regional (RA) or general (GA) anesthesia should be used to maintain hemodynamic stability and more favorable outcomes. Therefore, this meta-analysis examines the differences between RA and GA groups in the incidence of mortality, intraoperative hypotension, and other intra- and postoperative complications. The comparison is essential given the rising global prevalence of hip fractures and the need to optimize anesthesia strategies for improved patient outcomes, particularly in an aging population. We followed PRISMA guidelines (PROSPERO #CRD42022320413). We conducted the search for studies published in English before March 2022 in PubMed, Google Scholar, and the Cochrane Library. We included RCTs that compared general and regional anesthesia in adult patients having hip fracture surgical interventions. The primary outcome was perioperative mortality. The secondary outcomes were peri- or postoperative complications and duration of hospital stay. We conducted a meta-analysis in RevMan (version 5.4). We examined the quality of the methodology with the Cochrane risk of bias 2 tool, while the quality of evidence was determined with GRADE. Fifteen studies with 4110 patients were included. Our findings revealed no significant difference between general and regional anesthesia in risk of perioperative mortality (RR = 1.42 [0.96, 2.10], p-value = 0.08), intraoperative complications, or duration of hospital length of stay. Our results suggest that regional anesthesia and general anesthesia have comparable safety and can be used as alternatives based on specific patient requirements.