Assessing efficacy of intravenous acetaminophen for perioperative pain control for oocyte retrieval: a randomized, double-blind, placebo-controlled trial

Pain Management during Ultrasound Guided Transvaginal Oocyte Retrieval - A Narrative Review

Transvaginal oocyte retrieval (TVOR), done for the purpose of assisted reproduction can instigate enormous pain and therefore requires adequate analgesia with the least adverse effects. As the procedure involves retrieving oocytes for in vitro fertilisation, the effect of the anaesthetic drugs on the oocyte quality should also be considered. This review focuses on the various modes of anaesthesia and the anaesthetic drugs which can be administered safely to provide effective analgesia in normal and in special conditions such as women with pre-existing comorbidities. Medline, Embase, PubMed and Cochrane electronic databases were searched according to modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. According to this review, conscious sedation appears to be the most preferred mode of anaesthesia in women undergoing TVOR owing to fewer adverse effects, faster recovery, better patient and specialist comfort and the least effect on oocyte quality and embryo development. Combining it with paracervical block resulted in lesser consumption of the anaesthetic drug, which may have a beneficial effect on the oocyte quality.

EFFECT OF AUTOGENOUS BONE GRAFT SITE ON DENTAL IMPLANT SURVIVAL AND DONOR SITE COMPLICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVES

This systematic review and meta-analysis was undertaken to answer the following focus questions: Is the implant survival in augmented bone utilizing iliac crest bone grafts the same as while using intraoral autologous bone grafts? Is the incidence of postoperative donor site complications the same when using iliac crest bone grafts as opposed to intraoral grafts?

METHODS

Systematic searches of electronic databases (PubMed, Embase, CENTRAL) were performed to identify studies which reported on implant survival and postoperative complications for dental implants placed in grafted partially/completely edentulous human jaws. Studies were included if: they reported on 2-piece micro-rough surface root form dental implants placed in bone-augmented completely or partially edentulous human jaws, and the jaws must have been augmented with autologous bone graft materials. Time and nature of postoperative complications must have been reported. Two investigators performed data extraction and a Cohen's unweighted kappa was calculated for inter-investigator reliability. A meta-analysis was performed for the extracted data on implant survival rate in both iliac crest grafts and intra-oral grafts. A qualitative analysis was performed on the information extracted on graft donor site complications. Quality assessment of the included studies were done using the Cochrane collaboration tool and the Newcastle-Ottawa scales.

RESULTS

A total of 23 studies were included in the final analysis. The calculated kappa ranged between 0.77-0.89 for the literature search and identification process. Fourteen studies were included with data on implant survival including five randomized controlled clinical trials. The meta-analysis of included studies revealed that the implant survival rate of dental implants placed in jaws augmented with iliac crest grafts was lower than those placed in jaws augmented with intra-oral bone grafts at 6-months [ICG = 95.8% IOG = 98.4%; P < .001], 12-months [ICG = 97.0%, IOG = 98.4%; P < .001], 24-months [ICG = 85.9%, IOG = 98.2%; P < .001], 60-months [ICG = 90.0%, IOG = 91.5%; P < .001], and at 120-months [ICG = 88.8%, IOG = 95.2%; P < .001] follow-up periods. Iliac crest grafts were also frequently associated with donor site complications including pain / discomfort, gait disturbance, and sensory disturbance.

CONCLUSIONS

This systematic review and meta-analysis demonstrates that implant survival is consistently higher in bone harvested from intraoral sites compared to iliac crest grafts. Donor site complications seemed to be a frequent finding with iliac crest grafts and mental grafts.

FUNDING

None.

REGISTRATION

The review protocol was registered with PROSPERO: International prospective register of systematic reviews (CRD42021283738).