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Li Q, Xu S, Ou Y, Zhou L, Huang F, Jiang W, Xie H, Zou X, Gao J, Jin S, Zhou H, Huang Y, Pan Z, Liu J, Wang G, Li X, Sun C, Zhao L, Li L, Liu Q, Duan K, Wang S. Evaluating the efficacy and safety of perianal injection of liposomal ropivacaine HR18034 for postoperative analgesia following hemorrhoidectomy: A multicenter, randomized, double-blind, controlled phase II clinical trial. J Clin Anesth 2024; 97:111524. [PMID: 38941870 DOI: 10.1016/j.jclinane.2024.111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
STUDY OBJECTIVE HR18034, composed of the ropivacaine encapsulated in multi-lamellar, concentric circular structure liposomes as the major component and a small amount of free ropivacaine, has performed well in animal experiments and phase I clinical trials. This trial was to investigate the efficacy, safety, pharmacokinetic profile and the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy compared with ropivacaine. DESIGN A multicenter, randomized, double-blind trial. SETTING 19 medical centers in China. PATIENTS 85 patients undergoing hemorrhoidectomy between October 2022 to November 2022. INTERVENTIONS Patients were randomly divided into HR 18034 190 mg group, 285 mg group, 380 mg group and ropivacaine 75 mg group, receiving single local anesthetic perianal injection for postoperative analgesia. MEASUREMENTS The primary outcome was the area under the resting state NRS score -time curve within 72 h after injection. The second outcomes included the proportion of patients without pain, the proportion of patients not requiring rescue analgesia, cumulative morphine consumption for rescue analgesia, etc. Safety was evaluated by adverse events incidence and plasma ropivacaine concentrations were measured to explore the pharmacokinetic characteristics of HR18034. MAIN RESULTS The areas under the NRS score (at rest and moving states)-time curve were significantly lower in HR 18034 380 mg group than ropivacaine 75 mg at 24 h, 48 h, and 72 h after administration. However, this superiority was not observed in HR18034 190 mg group and 285 mg group. There was no difference in cumulative morphine consumption for rescue analgesia between HR 18034 groups and ropivacaine group. CONCLUSIONS HR 18034 380 mg showed superior analgesic efficacy and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose.
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Affiliation(s)
- Qiuwen Li
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Shouyu Xu
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Yangwen Ou
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Lianbang Zhou
- The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
| | - Furong Huang
- The First People's Hospital of Changde, Changde, People's Republic of China
| | - Wanwei Jiang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116011, People's Republic of China
| | - Haihui Xie
- Dongguan people's Hospital, Dongguan, Guangdong, People's Republic of China
| | - Xiaohua Zou
- The Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China
| | - Jihua Gao
- Traditional Chinese Medicine Hospital of Hebei Province, Shijiazhang,People's Republic of China
| | - Shu''an Jin
- Central Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Hongmei Zhou
- Jiaxing Second Hospital, Jiaxing, People's Republic of China
| | - Yanjuan Huang
- Nanning Second People's Hospital, Nanning, People's Republic of China
| | - Zhihao Pan
- Li Huili Hospital of Ningbo Medical Center, Ningbo, People's Republic of China
| | - Juying Liu
- Taihe Hospital Affiliated Hospital of Hubei University of medicine, Shiyan, People's Republic of China
| | - Guyan Wang
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Xiangkui Li
- Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - CanLin Sun
- Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Ling Zhao
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Lin Li
- General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qin Liu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Kaiming Duan
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Saiying Wang
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China.
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Unnikrishnan SP, Rampersaud E, Mcgee A, Cruickshank ME, Abu-Eid R, Hijazi K. Disease severity scoring systems in mucosal lichen planus: A systematic review. Oral Dis 2023; 29:3136-3151. [PMID: 36404123 DOI: 10.1111/odi.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
Several scoring systems have been developed to evaluate disease severity in mucosal lichen planus, but only a few have been validated to ensure reproducible and accurate assessment of disease severity. The current systematic review was undertaken to identify clinical severity scoring systems in mucosal lichen planus that have undergone validity or reliability testing and to describe their operating characteristics. We performed a bibliographic search in five databases from their inception to October 2022 for severity scoring systems in mucosal lichen planus that have undergone validity or reliability tests. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal tools. We have included 118 studies and identified 11 clinical severity scoring systems for oral lichen planus that have undergone validity or reliability testing. Of these, the most reported were the Thongprasom score, the Oral Disease Severity Score (ODSS) and the REU (Reticular/hyperkeratotic, Erosive/erythematous, Ulcerative) scoring systems. We did not identify clinical scoring systems for extraoral mucosal lichen planus that have undergone validity or reliability testing. The ODSS and REU scoring systems have undergone the highest number of validation attempts and reliability assessments for oral lichen planus respectively. However, we have identified numerous factors that have hampered the universal adoption of a standardised scoring system. There is a need for the development and validation of scoring systems for extraoral mucosal lichen planus.
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Affiliation(s)
- Sreedevi P Unnikrishnan
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Edward Rampersaud
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alice Mcgee
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Maggie E Cruickshank
- Aberdeen Centre for Women's Health Research, Aberdeen Maternity Hospital, Aberdeen, UK
| | - Rasha Abu-Eid
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Efficacy of Ultrasound-Guided Serratus Anterior Plane Block for Postoperative Analgesia in Patients Undergoing Breast Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Pain Res Manag 2021; 2021:7849623. [PMID: 34733377 PMCID: PMC8560299 DOI: 10.1155/2021/7849623] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/25/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022]
Abstract
Objective Serratus anterior plane block (SAPB) provides effective thoracic analgesia. This systematic review and meta-analysis was conducted to assess the safety and efficacy of SAPB for postoperative analgesia after breast surgery. Methods A systematic literature search was performed using Embase, PubMed, Web of Science, and the Cochrane Library for eligible randomised controlled trials. The primary outcomes involved the administration of intraoperative and postoperative opioids. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence for making recommendations. Results Overall, 13 studies comprising 826 patients met the inclusion criteria (412 in the SAPB group and 414 in the control group). Patients treated with SAPB exhibited a significantly lower postoperative opioid consumption (mean difference, −38.51 mg of oral morphine equivalent; 95% confidence interval (CI), −60.97 to −16.05; P < 0.01; I2 = 100%), whereas no difference was observed in the intraoperative opioid consumption (mean difference, −9.85 mg of oral morphine equivalent; 95% CI, −19.52 to −0.18; P=0.05; I2 = 94%). In addition, SAPB significantly decreased the occurrence of postoperative nausea and vomiting (risk ratio, 0.32; 95% CI, 0.19–0.55; P < 0.05;I2 = 38%) and reduced pain scores during the postoperative period (1 h: standardised mean difference (SMD), −1.23; 95% CI, −2.00 to −0.45; I2 = 92%; 2 h: SMD, −0.71; 95% CI, −1.00 to −0.41; I2 = 48%; 4 h: SMD, −1.52; 95% CI, −2.77 to −0.27; I2 = 95%; 6 h: SMD, −0.80; 95% CI, −1.51 to −0.08; I2 = 81%; 8 h: SMD, −1.12; 95% CI, −1.98 to −0.27; I2 = 92%; 12 h: SMD, −0.78; 95% CI, −1.21 to −0.35; I2 = 83%; and 24 h: SMD, −0.71; 95% CI, −1.20 to −0.23; I2 = 87%; P < 0.05 for all). Conclusion SAPB was safe and effective after breast surgery to relieve postsurgical pain. However, additional well-developed trials are required to validate these findings.
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