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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Nabiel, Rifaldy
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Medicine & Pharmacology

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A Systematic Review and Meta-Analysis of Paracervical Blocks as A Perioperative Strategy in Reducing Postoperative Pain in Patients Undergoing Laparoscopic Hysterectomy Nabiel, Rifaldy; Suseno, Daniel Alexander; Hadisubroto, Yonas; Gemawan, Taufiq; Anindito Putri, Aurellia Nuraini; Salsabila, Syadza; Sari, Eprila Darma
Indonesian Journal of Anesthesiology and Reanimation Vol. 5 No. 2 (2023): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V5I22023.112-121

Abstract

Introduction: Perioperative strategies to reduce postoperative pain are important for enhancing patient satisfaction. However, further research and trials has sparked ongoing debates of various strategies regarding efficacy and safety. Objective: This study aims to improve evidence-based strategies regarding the effect of paracervical anaesthetic blocks in patients undergoing laparoscopic hysterectomy. Methods: A systematic literature search was conducted through PubMed, Google Scholar, and ScienceDirect for RCTs in laparoscopic hysterectomy patients administered paracervical blocks and those given placebos. The quantitative analysis of pooled relative risk and mean difference with a 95% confidence interval were performed using the Review Manager 5.4 software in the random-effects model or fixed-effects model forest plot. Results: Based on four RCTs included in the analysis, there were significant differences in overall postoperative pain scores assessed by VAS (Visual Analogue Scale) [MD = -0.82, 95%CI (-1.47 to -1.06), p = 0.01]. The subgroup analysis also showed significant differences in VAS pain scores at 30 min and 1 hour post-operation [MD = -2.13, 95% CI (-3.09 to -1.16), p = 0.0001] and [MD = -2.55, 95% CI (-4.29 to -0.81), p = 0.004]. However, there were insignificant results in adequate pain control [RR = 7.90, 95%CI (0.39 to 158.67), p = 0.18], length of hospital stay [MD = 0.01, 95%CI (-0.52 to 0.54), p = 0.96], additional analgesics requirement at 24 hours [RR = 0.88, 95%CI (0.55 to 1.39), p=0.58], and perioperative complications [RR = 0.90, 95%CI (0.56 to 1.47), p = 0.68].Conclusion: This meta-analysis provides evidence that the administration of paracervical block in patients undergoing laparoscopic hysterectomy is associated with a reduction of postoperative VAS pain score but not associated with the length of hospital stay, adequate pain control, additional analgesics requirement at 24 hours, and perioperative complications.
AIMS65 Scoring System for Predicting Clinical Outcomes Among Emergency Department Patients with Upper Gastrointestinal Bleeding Nabiel, Rifaldy; Munawir, Al; Firdaus, Jauhar
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 1 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I12024.58-72

Abstract

Introduction: Several scoring systems were developed for early risk stratification in Upper Gastrointestinal Bleeding (UGIB) patients. AIMS65 score is a scoring system that only consists of five parameters, it might be used in daily clinical practice because of rapid and easy to calculate within 12 hours of admission. Objective: To evaluate the AIMS65 scoring system as a predictor of mortality, rebleeding events, need for endoscopic therapy, blood transfusion, and ICU admission for all causes of UGIB. Methods: We conducted a systematic review on PubMed, ScienceDirect, ProQuest, and Cochrane Library databases from the 2012 to 2022 publication period. We included either prospective or retrospective cohort studies that reported UGIB with all kinds of aetiologies who presented in the emergency department (ED), reported discriminative performance for each outcome, and reported the optimal cut-off of AIMS65. The primary measurement of discriminative performance for clinical outcomes includes mortality, rebleeding incidents, need for endoscopic therapy, blood transfusion, and ICU admission. Results: We identified 351 published studies, of which 20 were included in this study. Most of the studies reported discriminative performance for predicting mortality, which amounts to about 18 out of 20 studies. Rebleeding prediction was reported in 11 studies, need for endoscopic therapy in 5 studies, blood transfusion in 7 studies, and ICU admission in 2 studies. Most of the studies reported fair to excellent discriminative performance for predicting mortality, but in contrast for predicting rebleeding, the need for endoscopic therapy, blood transfusion, and ICU admission. Cut-off values≥ 2 are frequently reported to distinguish between high-risk and low-risk patients in mortality. Conclusion: AIMS65 can be applied to patients with UGIB in ED for predicting mortality, but not applicable for predicting rebleeding events, the need for endoscopic therapy, blood transfusion, and ICU admission. It enhances early decision-making and triage for UGIB patients.
Co-Authors Al Munawir Anindito Putri, Aurellia Nuraini Hadisubroto, Yonas Jauhar Firdaus Salsabila, Syadza Sari, Eprila Darma Suseno, Daniel Alexander Taufiq Gemawan