Quadratus lumborum block versus transversus abdominis plane block for inguinal hernia repair: A systematic review and meta-analysis with trial sequential analysis.

INTRODUCTION: Postoperative pain management is crucial for patient recovery with Quadratus Lumborum Block (QLB) and Transversus Abdominis Plane Block (TAPB) emerging as potential techniques. We aimed to compare the analgesic efficacy of QLB and TAPB in patients undergoing inguinal hernia repair. METHODS: We performed a systematic review of Cochrane, EMBASE, and MEDLINE databases to identify randomized controlled trials comparing QLB and TAPB in patients undergoing inguinal hernia repair. Outcomes included postoperative pain and opioid consumption. Statistical analysis was performed using RevMan 5.4. The review protocol was registered at PROSPERO (CRD42023445513). RESULTS: We included five RCTs encompassing 255 patients. QLB was associated with a significant decrease in postoperative pain (MD -0.45; 95% CI -0.75 to -0.14; and p = 0.004; I2  = 94%). However, we found no difference in 24-h opioid consumption between QLB and TAPB groups. CONCLUSION: QLB may offer superior pain reduction. However, its effect on opioid consumption remains unclear.

Proximal versus distal adductor canal catheters for total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Total knee arthroplasty (TKA) is associated with severe postoperative pain. Continuous adductor canal blockade provides analgesia while preserving quadriceps muscle strength. Nevertheless, uncertainty still exists as to the optimal adductor canal catheter placement approach. We sought to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the analgesic effects of proximal vs distal adductor canal catheters in patients undergoing TKA. SOURCE: We systematically searched PubMed, EMBASE, and Cochrane for RCTs comparing distal and proximal adductor canal catheters for TKA regarding critical clinical outcomes in adult patients. Statistical analysis was performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Heterogeneity was assessed using the Cochran Q test and I2 statistics. Trial sequential analysis (TSA) was performed to evaluate the risk of random errors and the uncertainty of our results. The risk of bias was appraised according to the RoB-2 tool. PRINCIPAL FINDINGS: Six RCTs and 352 patients were included, of whom 151 (42.9%) were male, and 175 (49.7%) were randomized to undergo proximal adductor canal catheter placement. Due to the randomized nature of the studies, baseline characteristics were similar between groups. There were no statistical differences between proximal and distal adductor canal catheters regarding cumulative opioid consumption in the first 24 hr (mean difference [MD], -4.86; 95% confidence interval [CI], -15.19 to 5.47; P = 0.36; four RCTs; 240 patients); pain scores at rest (MD, 0.41; 95% CI, -1.23 to 0.40; P = 0.32; six RCTs; 350 patients); and pain scores with movement for the first 24 hr (MD, -0.25; 95% CI, -0.85 to 0.35; P = 0.42; four RCTs; 246 patients). In the TSA, the required information size was not reached, and the Z-curve did not cross the monitoring boundaries in any of the endpoints. CONCLUSION: These findings suggest that proximal vs distal adductor canal catheter placement in patients undergoing TKA may be equally effective for the outcomes of opioid consumption in the first 24 hr, pain scores at rest, and pain scores with movement in the first 24 hr. Nevertheless, TSA findings suggest insufficient power to definitively conclude no differences between the two techniques. STUDY REGISTRATION: PROSPERO (CRD42022353576); registered 25 August 2022.

RéSUMé: OBJECTIF: L'arthroplastie totale du genou (ATG) est associée à une douleur postopératoire majeure. Le bloc continu du canal adducteur procure une analgésie tout en préservant la force musculaire du quadriceps. Néanmoins, il existe encore des incertitudes quant à l'approche optimale de positionnement du cathéter du canal adducteur. Nous avons cherché à réaliser une revue systématique et une méta-analyse d'études randomisées contrôlées (ERC) comparant les effets analgésiques de cathéters proximaux et distaux du canal adducteur chez la patientèle bénéficiant d'une ATG. SOURCES: Nous avons réalisé des recherches systématiques dans les bases de données PubMed, EMBASE et Cochrane pour en tirer les ERC comparant les cathéters distaux et proximaux du canal adducteur pour l'ATG touchant aux critères d'évaluation cliniques critiques chez les patient·es adultes. L'analyse statistique a été réalisée à l'aide de la version R 4.1.2 (R Foundation for Statistical Computing, Vienne, Autriche). L'hétérogénéité a été évaluée à l'aide du test Q de Cochran et des statistiques I2. Une analyse séquentielle des études a été réalisée pour évaluer le risque d'erreurs aléatoires et l'incertitude de nos résultats. Le risque de biais a été évalué selon l'outil RoB-2. CONSTATATIONS PRINCIPALES: Six ERC et 352 patient·es ont été inclus·es, dont 151 (42,9 %) hommes, et 175 (49,7 %) ont été randomisé·es pour bénéficier d'une pose proximale d'un cathéter du canal adducteur. En raison de la nature randomisée des études, les caractéristiques initiales étaient similaires entre les groupes. Il n'y avait aucune différence statistique entre les cathéters proximaux et distaux du canal adducteur en ce qui concerne la consommation cumulative d'opioïdes au cours des premières 24 heures (différence moyenne [DM], −4,86; intervalle de confiance [IC] à 95 %, −15,19 à 5,47; P = 0,36; quatre ERC; 240 patient·es); les scores de douleur au repos (DM, −0,41; IC 95 %, −1,23 à 0,40; P = 0,32; six ERC ; 350 patient·es); et les scores de douleur en mouvement pendant les premières 24 heures (DM, −0,25; IC 95 %, −0,85 à 0,35; P = 0,42; quatre ERC; 246 patient·es). Dans l'analyse séquentielle des études, la taille d'information requise n'a pas été atteinte et la courbe en Z n'a franchi les limites de surveillance dans aucun des paramètres. CONCLUSION: Ces résultats suggèrent que le positionnement proximal ou distal d'un cathéter du canal adducteur chez les personnes subissant une ATG peut être tout aussi efficace en ce qui touche aux critères de consommation d'opioïdes au cours des premières 24 heures, de scores de douleur au repos et de scores de douleur en mouvement au cours des premières 24 heures. Néanmoins, les résultats de l'analyse séquentielle suggèrent une puissance insuffisante pour conclure de manière définitive à l'absence de différences entre les deux techniques. ENREGISTREMENT DE L'éTUDE: PROSPERO (CRD42022353576); enregistrée le 25 août 2022.

Heavyweight versus non-heavyweight mesh in ventral hernia repair: a systematic review and meta-analysis.

PURPOSE: There is considerable variability among surgeons regarding the type of mesh used in ventral hernia repair. There has been an increasing incidence of mesh fractures with lightweight (LW) and mediumweight (MW) meshes. However, HW mesh has been associated with a greater foreign body sensation and chronic pain. This meta-analysis aims to compare the outcomes of HW and non-heavyweight (NHW) meshes in ventral hernia repair. METHODS: We systematically reviewed the PubMed, Embase, Cochrane, and Scopus databases to identify studies comparing HW with NHW meshes in hernia repair. Outcomes analyzed included hernia recurrence, seroma, hematoma, foreign body sensation, postoperative pain, and wound infection. We performed two subgroup analyses focusing on randomized controlled trials and open retromuscular repairs. Statistical analysis was performed using RevMan 5.4. RESULTS: We screened 1704 studies. Nine studies were finally included in this meta-analysis and comprised 3001 patients from 4 RCTs and 5 non-randomized. The majority of patients (57.1%) underwent open retromuscular repair. HW mesh was significantly associated with increased in foreign body sensation (OR 3.71; 95% CI 1.40-9.84; p = 0.008), but there was no difference in other outcomes. In RCTs analysis, there was no difference between meshes. In open retromuscular repairs, HW mesh was associated with more seromas (OR 1.48; 95% CI 1.01-2.17; p = 0.05). CONCLUSION: Our study found that HW mesh was associated with more foreign body sensation. Also, open retromuscular repairs analysis showed that HW was associated with more seromas. Further randomized studies are needed to understand better the role of HW mesh in ventral hernia repair.

Geospatial Analysis of Accessibility to Surgical Care, a Brazilian Local Perspective.

BACKGROUND: Surgical care has been neglected and recently discussed by the World Health Organization as a necessary component of health care. Situations that distance individuals and medical services are of particular concern. We aim to estimate the distance a patient who lives in a municipality without a general surgeon would have to travel to access surgical care; and to describe the geographical distribution of the surgical workforce. METHODS: We obtained the surgical data from DATASUS, from IBGE, the information regarding the classification of each municipality and its location, and FEPAM, the road network. We performed the geoprocessing analysis on QGIS and the statistical analysis on SPSS. RESULTS: The Rio Grande do Sul state had 496 municipalities, of which 69.4% were rural, with a mean of 9.19 general surgeons per overall municipality. A total of 237 cities had no general surgeons, of which 89.45% were in rural ones. There was a significant difference in the number of surgeons per municipality between rural and urban ones. We found a mean of 22.09 surgeons per 100,000 population. The mean distance traveled by a patient to a municipality with general surgeons available was 30.25 km, with a minimum of 2.46 km and a maximum of 268.22 km. CONCLUSIONS: Disparities are associated with the geospatial distribution of surgical care in the Rio Grande do Sul state. The surgical workforce and the distance a patient travels are irregular geographically. This study is the start of inspiring other similar studies about geospatial surgical analysis.

Surgical Treatment of the Five Most Common Types of Cancer in Brazil: 7 Years Analysis Overview.

BACKGROUND: Surgery is the main treatment for the majority of solid cancers. Studies investigating surgical interventions are a critical asset in improving patient health outcomes. We aim to analyze the temporal and spatial distribution of the surgical treatment of Brazil's 5 most common types of cancer. METHODS: The selected cancers were stomach, colorectal and rectosigmoid junction, bronchial and lung, breast, and prostatic. Surgical data were collected from the DATASUS database from 2013 to 2019. Statistical analyses included linear regression tests with a significance level of .05. RESULTS: From 2013 to 2019, 19.72% of the diagnoses of all cancers were treated surgically. Only breast cancer didn't have a significant linear increase in surgeries (P = .702). Prostatic cancer had the highest annual increase rate and breast the lowest. Analyzing the Brazilian regions, the Southeast had the highest incidence of oncological surgeries, and the Midwest had the lowest. DISCUSSION: Brazil's surgical oncology scenario is progressing positively through the analyzed period. The analysis of the 5 most common types of cancer in Brazil and their progression over the years provides an idea of the cancer surgery capacity in Brazil. There were disparities between the Brazilian regions in all types of cancer. Our study is the first step to better comprehending cancer care in Brazil and the access issues that some areas have. With that, it will be possible to provide better care to cancer patients needing surgical treatment.

Gender-Related Trends in Publication Authorship: A 10-Year Analysis of a Brazilian Surgical Journal.

There is a gender gap in the representation of women in the authorship of surgical literature worldwide. In Brazil, data on the gender distribution of the authorship of articles are scarce; and hence, there is a lack of awareness about the contemporary situation of women surgeons within the academic surgery in the country. In light of this, we conducted this study with an aim to describe and evaluate the authorship trends in a Brazilian surgical journal over a period of 10 years (2010-2019). We included 4,301 authors from 792 articles extracted from 60 editions of this journal. We analyzed the female representation as authors in general, first and last authors, and the female surgeons' representation as first and last authors for 568 original articles. We found that, in general, women represented 27.8% of all authors. Regarding original articles, women surgeons represented 8.4% and 6.1% of first and last authors, respectively. The linear regression analysis demonstrated that there was an increase over the years in women authorship. However, despite this increase over the years, a gender gap still persists in terms of women's representation as authors in the Brazilian surgical literature.