Comparison of different nonsteroidal anti-inflammatory drugs for cesarean section: a systematic review and network meta-analysis.

BACKGROUND: Cesarean section is associated with moderate to severe pain and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed. The optimal NSAID, however, has not been elucidated. In this network meta-analysis and systematic review, we compared the influence of control and individual NSAIDs on the indices of analgesia, side effects, and quality of recovery. METHODS: CDSR, CINAHL, CRCT, Embase, LILACS, PubMed, and Web of Science were searched for randomized controlled trials comparing a specific NSAID to either control or another NSAID in elective or emergency cesarean section under general or neuraxial anesthesia. Network plots and league tables were constructed, and the quality of evidence was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis. RESULTS: We included 47 trials. Cumulative intravenous morphine equivalent consumption at 24 h, the primary outcome, was examined in 1,228 patients and 18 trials, and control was found to be inferior to diclofenac, indomethacin, ketorolac, and tenoxicam (very low quality evidence owing to serious limitations, imprecision, and publication bias). Indomethacin was superior to celecoxib for pain score at rest at 8-12 h and celecoxib + parecoxib, diclofenac, and ketorolac for pain score on movement at 48 h. In regard to the need for and time to rescue analgesia COX-2 inhibitors such as celecoxib were inferior to other NSAIDs. CONCLUSIONS: Our review suggests the presence of minimal differences among the NSAIDs studied. Nonselective NSAIDs may be more effective than selective NSAIDs, and some NSAIDs such as indomethacin might be preferable to other NSAIDs.

Neural-electronic inhibition simulated with a neuron model implemented in SPICE.

There have been numerous studies presented in the literature related to the simulation of the interaction between biological neurons and electronic devices. A complicating factor associated with these simulations is the algebraic complexity involved in implementation. This complication has impeded simulation of more involved neural-electronic circuitry and consequently has limited potential advancements in the integration of biological neurons with synthetic electronics. In this paper, we describe a modification to a previously proposed SPICE based Hodgkin-Huxley neuron model that demonstrates more physiologically relevant electrical behavior. We utilize this SPICE based neuron model in conjunction with an external circuit that allows for artificial selective inhibition of neural spiking. The neural firing control scheme proposed herein would allow for action potential frequency modulation of neural activity that, if developed further, could potentially be applied to suppress undesirable neural activity that manifests symptomatically as the tremors or seizures associated with specific pathologies of the nervous system.