Efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery: a systematic review and meta-analysis / Eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica de hombro: una revisión sistemática y metanálisis

Abstract: Objective: To assess the efficacy and safety of preemptive analgesia with gabapentinoids for patients undergoing arthroscopic shoulder surgery. Material and methods: A PRISMA-compliant systematic review and meta-analysis was conducted in PubMed, Cochrane Library and ScienceDirect databases. Randomized Controlled Trials (RCTs) comparing gabapentinoids (gabapentin and pregabalin) with placebo in patients undergoing shoulder arthroscopic surgery were retrieved. The primary endpoint was the visual analogue scale (VAS) score at 24 hours and cumulative morphine consumption at 24 hours. The secondary outcomes were complications of nausea/vomiting, sedation and dizziness. After tests for publication bias and heterogeneity among studies were performed, data were aggregated for random-effects models when necessary. Results: Five clinical studies (gabapentin group n = 4 and pregabalin group n = 1) were ultimately included in the meta-analysis. Gabapentinoids were associated with reduced pain scores at 24 hours. Similarly, gabapentinoids were associated with a reduction in cumulative morphine consumption at 24 hours. Furthermore, gabapentinoids can significantly reduce the occurrence of nausea/vomiting. There were no significant differences in the occurrence of sedation and dizziness. Conclusions: Preoperative use of gabapentinoids was able to reduce postoperative pain, total morphine consumption, and morphine-related complications following arthroscopic shoulder surgery. Further studies should determine the optimal dose and whether pregabalin is superior to gabapentin in controlling acute pain after shoulder surgery.

Resumen: Objetivo: Evaluar la eficacia y seguridad de la analgesia preventiva con gabapentinoides para pacientes sometidos a cirugía artroscópica del hombro. Material y métodos: Se llevó a cabo una revisión sistemática y metaanálisis conforme a PRISMA en las bases de datos PubMed, Cochrane Library y ScienceDirect. Se recuperaron ensayos controlados aleatorios (RCT) que comparaban los gabapentinoides (gabapentina y pregabalina) con placebo en pacientes sometidos a cirugía artroscópica del hombro. El punto final principal fue la puntuación de la escala analógica visual (VAS) a las 24 horas y el consumo acumulado de morfina a las 24 horas. Los resultados secundarios fueron complicaciones de náuseas/vómitos, sedación y mareos. Después de realizar pruebas de sesgo de publicación y heterogeneidad entre los estudios, se agregaron datos para modelos de efectos aleatorios cuando fue necesario. Resultados: En última instancia, se incluyeron en el metaanálisis cinco estudios clínicos (grupo de gabapentina n = 4 y grupo de pregabalina n = 1). Los gabapentinoides se asociaron con puntuaciones de dolor reducidas a las 24 horas. Del mismo modo, los gabapentinoides se asociaron con una reducción en el consumo acumulado de morfina a las 24 horas. Además, los gabapentinoides pueden reducir significativamente la aparición de náuseas/vómitos. No hubo diferencias significativas en la ocurrencia de sedación y mareos. Conclusiones: El uso preoperatorio de gabapentinoides fue capaz de reducir el dolor postoperatorio, el consumo total de morfina y las complicaciones relacionadas con la morfina después de la cirugía artroscópica del hombro. Otros estudios deben determinar la dosis óptima y si la pregabalina es superior a la gabapentina en el control del dolor agudo después de la cirugía de hombro.

Reaction-diffusion model for pattern formation in E. coli swarming colonies with slime.

A new experimental colonial pattern and pattern transition observed in E. coli MG1655 swarming cells grown on semisolid agar are described. We present a reaction-diffusion model that, taking into account the slime generated by these cells and its influence on the bacterial differentiation and motion, reproduces the pattern and successfully predicts the observed changes when the colonial collective motility is limited. In spite of having small nonhyperflagellated swarming cells, under these experimental conditions E. coli MG1655 can very rapidly colonize a surface, with a low branching rate, thanks to a strong fluid production and a locally incremented density of motile, lubricating cells.