Hospital Practices and Research

Abstract Background: Knee Osteoarthritis (OA) is a common degenerative joint disease characterized by ongoing pain and reduced physical function.
Objectives: We aimed to systematically review and meta-analyze the clinical trials that evaluated the impact of transcranial Direct Current Stimulation (tDCS) on knee OA pain.
Methods: A comprehensive search was performed on Scopus, Web of Science, PubMed/MEDLINE, EMBASE, ProQuest, CENTRAL via Cochrane, and PEDro from the inception of these databases until May 31, 2023 with no language restrictions. The objective of the search was to find publications that examined the impact of active tDCS compared to sham tDCS or other interventions in individuals with knee OA.
Results: The meta-analysis comprised ten studies including 517 patients with knee OA. Active tDCS resulted in significantly lower pain scores compared to sham tDCS/ Transcutaneous Electrical Nerve Stimulation (TENS) immediately (effect sizes from pre-test–post-test-control design (dppc2) = -0.83, I² = 61.8%), short-term (dppc2 = -0.74, I² = 43.5%), and mid-term (dppc2 = -1.94, I² = 87.8%) follow-ups, but not in the long term (dppc2 = -0.25, I² = 29.6%). However, the certainty of the evidence was assessed as low to very low.  Moreover, function was significantly improved with active tDCS immediately after the last treatment session either by McMaster Universities Osteoarthritis Index (WOMAC) or Knee Injury and Osteoarthritis Outcome Score (KOOS) (dppc2 = -0.38, I² = 6.6% and dppc2 = 0.87, I² = 60.1%, respectively). The certainty of the evidence was very low. No serious adverse effects of tDCS were reported by the majority of studies.
Conclusion: More than half of the included trials had unclear or high risk of bias and there were no patient follow-ups beyond three months. Given the criteria of reduced I² and sufficient number of studies, no potential sources of heterogeneity were identified. Further high-quality randomized clinical trials with extended follow-up periods are required to determine the true effects of tDCS on knee OA.

Abstract Background: Seeking local evidence on treatment efficacy is necessary if cultural factors are involved, as in psychotherapy for Chronic Pain (CP). Yet, local evidence is known to be prone to bias, making it difficult to reach reliable conclusions.
Objectives: This study aimed to critically evaluate our local evidence on the efficacy of psychotherapy on quality of life and disability in CP. It has been elaborated that, with some requirements, common meta-analytic tools can be utilized to detect and correct local evidence bias.
Methods: The protocol was registered on PROSPERO, Record [deleted for blind review]. Elmnet, Pubmed, and ProQuest were searched for randomized trials. A multilevel meta-analysis was used to capture the hierarchical structure of the data, and robust variance estimation was used for inference. Several moderation analyses were conducted, and publication and other related sources of bias were examined.
Results: Forty-two trials were initially included. Six were excluded before the analysis due to serious reporting problems undermining their validity. The SMD from 185 effect sizes was 1.08 [.87, 1.3]. The funnel plot showed a strong bias. The bias-corrected estimate from a regression-based method was 0.45 [0.04, 0.87], and from the trim-and-fill was 0.75 [0.48, 1.0].
Conclusion: While our original estimate was large, the corrected estimation showed a medium effect, fairly comparable to the international estimates. Current evidence on different sources of bias in our literature suggests low quality and questionable research practice as the first suspects for our local evidence bias.

Abstract Background: There is scant data on the effectiveness and safety of adjuvant perioperative intravenous (IV) lidocaine in procuring postoperative analgesia and rehabilitation in gynecology surgery in low-resource settings.
Objectives: To evaluate the effects of IV lidocaine on postoperative pain and rehabilitation gynecology surgery.
Methods: We carried out a randomized single-blinded controlled trial from April to August 2017 (5 months) at the Yaoundé Gynaecology, Obstetrics and Pediatrics Hospital, Cameroon. The study population was made up of ASA 1 and 2, women admitted for elective gynecological surgery under general anesthesia divided into two groups of 17 patients: those to receive IV lidocaine and those to receive normal saline as placebo both intra-and postoperatively as an adjuvant to standard care. The variables studied included the additional doses of fentanyl, postoperative pain, side effects of lidocaine, time to first bowel sounds, the ease with which patients were mobilized and patient satisfaction.
Results: Compared to patients in the placebo group, those in the lidocaine group had fewer mean amounts of fentanyl reinjections (P<0.0001), shorter recovery time (P=0.0044), reported lesser pain in the immediate postoperative period (P=0.012) till the 3^rd postoperative hour (P<0.001), had more early postoperative bowel sounds (94.1% vs. 11.8%), rehabilitated earlier (P<0.001) and were more satisfied with pain management (P=0.001). The lone observed side effect of IV lidocaine was tolerable bradycardia in six (35.3%) patients.
Conclusion: Adjuvant IV lidocaine can be effectively used in gynecological surgery, with the advantage of better postoperative analgesia, quicker rehabilitation and minimal side effects.

Abstract Background: Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions.
Objectives: The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries.
Methods: This randomized control clinical trial study was carried out from December 2018 to October 2020, on ASA I and II patients aged between 30-80 years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (18 cases), and group II received fentanyl and morphine bolus injection (18 cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded.
Results: The mean age was 52.21±16.13 years (41.6% male, 58.4 female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P < 0.05). There were no differences between the two groups regarding PLT, ESR, CRP, and PCT preoperative postoperative (P > 0.05). The mean of pain was less in the epidural group than in the morphine group postoperative (P = 0.02).
Conclusion: The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.