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A meta-analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper-limb orthopaedic trauma surgery.

ABSTRACT: The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper-limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta-analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper-limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P < 0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P < 0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P < 0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side-effects. There is moderate-quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper-limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety-profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine-related neurological safety in future studies.

SUBMITTER: Shi W

PROVIDER: S-EPMC10088860 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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A meta-analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper-limb orthopaedic trauma surgery.

Shi Wei W Dong Jing J Chen Jian-Feng JF Yu Hai H

International wound journal 20221103 5

The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper-limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta-analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper-limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean diff ...[more]

PMID: 36330591

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Project description:BackgroundThe COVID-19 pandemic halted elective orthopaedic surgeries, necessitating alternative consultation methods. Virtual consultations emerged as a solution to manage elective waiting lists for conditions such as carpal tunnel syndrome, stenosing tenosynovitis and Dupuytren's contractures. This study aimed to evaluate the effectiveness and patient satisfaction of virtual consultations in an upper-limb orthopaedic clinic.Local problemElective waiting lists for conditions such as carpal tunnel syndrome, stenosing tenosynovitis and Dupuytren's contractures increased significantly, requiring alternative consultation methods.MethodsThe Virtual Upper-Limb Clinic was composed of a virtual consultation, which included a focused history and examination. If there is uncertainty of diagnosis or a lack of appropriate examination findings at that time, the patient would then be booked into an in-person clinic for further assessment.If the virtual examination demonstrated marked pathology, surgical treatment would be proposed. Patients accepting surgical management were assessed and diagnosed formally on the day of surgery, followed by another virtual consultation postoperatively. The aim of this study is to demonstrate overall advantages and patient experiences of the virtual clinic. Data were collected in a retrospective manner using an improvised questionnaire based on the Telehealth Satisfaction Scale.InterventionsPatients received focused history and examination assessments via video consultation. Surgical treatment was carried out electively if required, followed by a postoperative virtual review.ResultsFifty patients were included, predominantly female, with an average age of 57.48 years. Diagnoses included 25 carpal tunnel cases, 15 trigger fingers, two ganglion cysts and eight Dupuytren's contractures. Ninety-six per cent of patients were satisfied with the virtual service, citing reduced travel costs and convenience. However, only 54% preferred virtual consultations preoperatively.ConclusionsVirtual upper-limb orthopaedic clinics provide a safe, cost-effective and satisfactory alternative to in-person care. However, preferences varied, underscoring the need for a hybrid model integrating virtual and in-person consultations based on clinical and patient needs.

Project description:ObjectiveUpper limb (UL) disability in people with UL loss is well reported in the literature, less so for people with lower limb loss. This study aimed to compare UL disability in injured (major trauma) and uninjured UK military personnel, with particular focus on people with upper and lower limb loss.MethodsA volunteer sample of injured (n = 579) and uninjured (n = 566) UK military personnel who served in a combat role in the Afghanistan war were frequency matched on age, sex, service, rank, regiment, role, and deployment period and recruited to the Armed Services Trauma Rehabilitation Outcome (ADVANCE) longitudinal cohort study. Participants completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, scored from 0 (no disability) to 100 (maximum disability) 8 years postinjury. Mann-Whitney U and Kruskal-Wallis tests were used to compared DASH scores between groups. An ordinal model was used to assess the effect of injury and amputation on DASH scores.ResultsDASH scores were higher in the Injured group compared to the Uninjured group (3.33 vs 0.00) and higher in people with lower limb loss compared to the Uninjured group (0.83 vs 0.00), although this was not statistically significant. In the adjusted ordinal model, the odds of having a higher DASH score was 1.70 (95% CI = 1.18-2.47) times higher for people with lower limb loss compared to the Uninjured group. DASH score was not significantly different between people with major and partial UL loss (15.42 vs 12.92). The odds of having a higher DASH score was 8.30 (95% CI = 5.07-13.60) times higher for people with UL loss compared to the Uninjured group.ConclusionPeople with lower limb loss have increased odds of having more UL disability than the Uninjured population 8 years postinjury. People with major and partial UL loss have similar UL disability. The ADVANCE study will continue to follow this population for the next 20 years.ImpactFor the first time, potential for greater long-term UL disability has been shown in people with lower limb loss, likely resulting from daily biomechanical compensations such as weight-bearing, balance, and power generation. This population may benefit from prophylactic upper limb rehabilitation, strength, and technique.

Dataset Information

A meta-analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper-limb orthopaedic trauma surgery.

Publications

A meta-analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper-limb orthopaedic trauma surgery.

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