Efficacy of Transversus Abdominis Plane Block in the Reduction of Pain and Opioid Requirement in Laparoscopic and Robot-assisted Hysterectomy: A Systematic Review and Meta-analysis / Eficácia do bloqueio transverso do plano abdominal na redução da dor e da necessidade de opioides em histerectomia laparoscópica e assistida por robô: Uma revisão sistemática e metanálise

Abstract Objective To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. Data Sources We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. Method of Study Selection Two researchers independently evaluated the eligibility of the selected articles. Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2=68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2=69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2=80%); and incidence of nausea and vomiting with a difference of 95%CI=- 0.11 (- 0.215-0.006) in favor of TAP. Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. Clinical Trial Number and Registry: PROSPERO ID - CRD42018103573.

Resumo Objetivo Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica. Fontes de Dados Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô. Métodos de Seleção de Estudos Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados. Tabulação, Integração e Resultados Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nasmédias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87-0 46) nos escores da escala de dor (I2=68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043-044; I2=69%); necessidade de opioides: DM0 36 (95%CI: - 0 94-168; I2=80%); e incidência de náuseas e vômitos com diferença de 95% CI=- 011 (- 0215-0006) a favor do TAP. Conclusão Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pósoperatória inicial. Número e Registro do Ensaio Clínico: PROSPERO ID - CRD42018103573.

Algunos factores relacionados con la estética dental: una nueva aproximación / Some factors associated to cosmetic dentistry: a new approach

Introducción: el propósito de este estudio fue determinar el comportamiento de algunos factores que influyen en la estética dental en estudiantes de la Facultad de Odontología de la Universidad de Antioquia (F. de O. de la U. de A.), entre 18 y 30 años de edad, de ambos géneros. Métodos: estudio descriptivo-transversal en 203 estudiantes de la F. de O. de la U. de A. Se registraron medidas directas en los seis dientes anteriores maxilares, con un "Pie de rey" digital (Digimatic)® y se tomaron fotografías del tercio inferior de cara. Para el análisis estadístico, se utilizó SPSS 17. Se obtuvieron las medidas descriptivas y, luego de realizar las pruebas de distribución normal, se realizó una prueba t de student para establecer diferencia de medias entre las proporciones ideales de los incisivos laterales. Resultados y conclusiones: en los hombres, la Línea Media Facial (LMF) coincidió con la Línea Dentaria Superior en el 61,4% de los casos, y las dentarias entre sí en el 38,6%. En las mujeres, la LMF coincidió con la Línea Dentaria Superior en el 62,25% y las dentarias, entre sí, en el 31,1%. Ningún individuo presentó las proporciones doradas entre el incisivo central y lateral superior. El rango más prevalente de la Proporción Dentaria Individual (PDI) fue el superior al 80%. La longitud promedio del labio superior para mujeres fue de 21,41 mm y del inferior 47,18 mm; para los hombres, el labio superior fue 22,78 mm y el inferior 52,45 mm. La posición del margen gingival del incisivo lateral superior más frecuente fue la incisal, en ambos sexos.

Introduction: the purpose of this study was to determine the behavior of some factors influencing dental esthetics in male and female students of Universidad de Antioquia School of Dentistry (FOUA for its Spanish initials), aged 18 to 30 years. Methods: this was a descriptivetransversal study on 203 FOUA students. Direct measurements of the six maxillary anterior teeth were recorded with a digital Vernier caliper (Digimatic)® and the lower third of the face was photographed. The statistical analysis was conducted with SPSS 17. Descriptive measurements were obtained and a Student's t test was performed after testing normal distribution, in order to establish mean differences between the ideal proportions of lateral incisors. Results and conclusions: in males, the Facial Midline (FML) coincided with the Upper Teeth Line in 61.4% of the cases and both teeth lines coincided with each other in 38.6%. In females, the FML coincided with the Upper Teeth Line in 62.25% and both teeth lines coincided with each other in 31.1%. None of the subjects had the Golden Proportion between central and lateral upper incisors. The most prevalent Individual Tooth Ratio (ITR) range was the one over 80%. The average length of females' upper lip was 21.41 mm and the bottom lip 47.18 mm; in males, the upper lip measured 22.78 mm in average and the bottom lip 52.45 mm. In both sexes, the most frequent position of the upper lateral incisors' gingival margin was the incisal one.