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PLoS One ; 12(9): e0184649, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28953949


BACKGROUND: Tramadol, a 4-phenyl-piperidine analog of codeine, has a unique action in that it has a central opioidergic, noradrenergic, serotonergic analgesic, and peripheral local anesthetic (LA) effect. Many studies have reported contradictory findings regarding the peripheral analgesic effect of tramadol as an adjuvant to LA in brachial plexus block (BPB). This meta-analysis aimed to evaluate the effects of tramadol as an adjunct to LA in BPB during shoulder or upper extremity surgery. METHODS: We searched the PubMed, EMBASE, Cochrane, KoreaMed databases, and Google Scholar for eligible randomized controlled trials (RCTs) that compared BPB with LA alone and BPB with LA and tramadol. Primary outcomes were the effects of tramadol as an adjuvant on duration of sensory block, motor block, and analgesia. Secondary outcomes were the effects of tramadol as an adjuvant on time to onset of sensory block and motor block and on adverse effects. We performed the meta-analysis using Review Manager 5.3 software. RESULTS: We identified 16 RCTs with 751 patients. BPB with tramadol prolonged the duration of sensory block (mean difference [MD], -61.5 min; 95% CI, -95.5 to -27.6; P = 0.0004), motor block (MD, -65.6 min; 95% CI, -101.5 to -29.7; P = 0.0003), and analgesia (MD, -125.5 min; 95% CI, -175.8 to -75.3; P < 0.0001) compared with BPB without tramadol. Tramadol also shortened the time to onset of sensory block (MD, 2.1 min; 95% CI, 1.1 to 3.1; P < 0.0001) and motor block (MD, 1.2 min; 95% CI, 0.2 to 2.1; P = 0.010). In subgroup analysis, the duration of sensory block, motor block, and analgesia was prolonged for BPB with tramadol 100 mg (P < 0.05) but not for BPB with tramadol 50 mg. The quality of evidence was high for duration of analgesia according to the GRADE system. Adverse effects were comparable between the studies. CONCLUSIONS: In upper extremity surgery performed under BPB, use of tramadol 100 mg as an adjuvant to LA appears to prolong the duration of sensory block, motor block, and analgesia, and shorten the time to onset of sensory and motor blocks without altering adverse effects.

Adjuvantes Farmacêuticos , Anestésicos Locais/farmacologia , Bloqueio do Plexo Braquial , Tramadol/farmacologia , Humanos
J Int Med Res ; 44(3): 405-18, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27009026


BACKGROUND: A meta-analysis and systematic review of randomized controlled trials to compare the oropharyngeal leak pressure (OLP) and clinical performance of LMA ProSeal™ (Teleflex® Inc., Wayne, PA, USA) and i-gel® (Intersurgical Ltd, Wokingham, UK) in adults undergoing general anesthesia. METHODS: Searches of MEDLINE®, EMBASE®, CENTRAL, KoreaMed and Google Scholar® were performed. The primary objective was to compare OLP; secondary objectives included comparison of clinical performance and complications. RESULTS: Fourteen RCTs were included. OLP was significantly higher with LMA ProSeal™ than with i-gel® (mean difference [MD] -2.95 cmH2O; 95% confidence interval [CI] -4.30, -1.60). The i-gel® had shorter device insertion time (MD -3.01 s; 95% CI -5.80, -0.21), and lower incidences of blood on device after removal (risk ratio [RR] 0.32; 95% CI 0.18, 0.56) and sore throat (RR 0.56; 95% CI 0.35, 0.89) than LMA ProSeal™. CONCLUSION: LMA ProSeal™ provides superior airway sealing compared to i-gel®.

Máscaras Laríngeas , Pressão , Adulto , Remoção de Dispositivo , Humanos , Máscaras Laríngeas/efeitos adversos , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto