MP16-09 SAFETY AND EFFICACY OF TRANSURETHRAL RESECTION OF BLADDER TUMOUR COMPARING SPINAL ANAESTHESIA TO SPINAL ANAESTHESIA WITH AN OBTURATOR NERVE BLOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS
Notice bibliographique
Résumé
You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-09 SAFETY AND EFFICACY OF TRANSURETHRAL RESECTION OF BLADDER TUMOUR COMPARING SPINAL ANAESTHESIA TO SPINAL ANAESTHESIA WITH AN OBTURATOR NERVE BLOCK: A SYSTEMATIC REVIEW AND META-ANALYSIS Anil Krishan, Angus Bruce, Shehab Khashaba, Mohamed Abouelela, and Syed Ali Ehsanullah Anil KrishanAnil Krishan More articles by this author , Angus BruceAngus Bruce More articles by this author , Shehab KhashabaShehab Khashaba More articles by this author , Mohamed AbouelelaMohamed Abouelela More articles by this author , and Syed Ali EhsanullahSyed Ali Ehsanullah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for transurethral resection of bladder tumours (TURBT) during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosol-generating procedures. We aimed to compare outcomes of TURBT using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity. METHODS: We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar and Web of Science), identifying studies comparing the outcomes of TURBT using spinal anaesthesia versus spinal with an obturator nerve block. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data. RESULTS: Searches of electronic databases resulted in 107 articles, from which four randomised control trials (RCTs) and three cohort studies met the eligibility criteria, enrolling a total of 448 patients. The use of spinal anaesthesia with an obturator nerve block was associated with a significantly reduced risk of obturator reflex (p <0.00001), bladder perforation (p=0.02), incomplete resection (p <0.0001) and 12-month tumour recurrence (p=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity (0/159). CONCLUSIONS: Our meta-analysis suggests that TURBT employing spinal anaesthesia with an obturator nerve block is superior to the use of spinal anaesthesia alone. During the COVID-19 pandemic, where avoidance of aerosol-generating procedures (AGPs) such as a general anaesthesia is paramount, the use of an obturator nerve block with spinal anaesthesia is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade. Source of Funding: Nil © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e299-e300 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anil Krishan More articles by this author Angus Bruce More articles by this author Shehab Khashaba More articles by this author Mohamed Abouelela More articles by this author Syed Ali Ehsanullah More articles by this author Expand All Advertisement Loading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,008 | 0,023 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».