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PubMed1999

Fixed-dose combination vs monotherapy in hypertension: a meta-analysis evaluation.

Fixed-dose combination antihypertensive therapy has received interest since the publication of the JNC-VI report. Relatively few head-to-head comparative studies between fixed-dose combinations and first-line monotherapies for hypertension have been published. The objective of this study was to conduct a meta-analysis of various first-line monotherapies and the fixed-dose combination of amlodipine/benazepril. The results of the meta-analysis were used to compare the efficacy and safety of the first-line monotherapies with amlodipine/benazepril. The meta-analysis included 82 studies that included 110 treatment groups (cohorts). The study compared nine different monotherapies and one combination therapy (amlodipine/benazepril). Of the 82 studies, 22 were placebo-controlled and 60 were active treatment controlled. The mean absolute decrease in supine diastolic blood pressure (BP) ranged from 9.7 to 13.3 mm Hg with verapamil showing the greatest effect and captopril the least (13.3 +/- 3.0 mm Hg; 9.7 +/- 2.9 mm Hg, respectively). When studies were weighted by sample size, atenolol, verapamil, lisinopril and amlodipine/benazepril showed the greatest BP effect. When studies were weighted by variance, amlodipine/benazepril and atenolol showed the greatest BP effect. The percentage of patients controlled on therapy ranged from 54% to 79%. Lisinopril and amlodipine/benazepril showed the greatest percent controlled. The overall incidence of adverse effects ranged from 12.1% to 41.8% with lisinopril having the lowest and nifedipine having the highest incidence. The overall incidence of adverse effects resulting in drug discontinuance ranged from 1.3% to 10.7%, with amlodipine/benazepril having the lowest and nifedipine having the highest incidence. The results of the meta-analysis indicate that amlodipine/benazepril produces above average reductions in BP with a lower than average incidence of overall side effects and the lowest incidence of adverse effects resulting in drug discontinuance. The fixed-dose combination of amlodipine/benazepril achieves its goal of effective BP lowering with a minimum of significant side effects.

Amlodipine↗

PubMed1997

Meta-analysis of response time data in a single experiment.

Conventional analysis based on mean response times does not fully utilize data and also ignores the difference in precision among the means by weighting each mean equally. A meta-analysis was applied to the reaction time data obtained from the Stroop color-naming task in a single experiment which employed a mixed design. It treated each subject as an independent replication of the same experiment and the same hypothesis. Individual subjects' data were first analyzed with a time-series regression adjusting for lag 1 autocorrelation. Results from these analyses were, then, combined to estimate the over-all effect size as well as significance level. A between-subject factor was also analyzed to assess its influence on the effect sizes and the significance levels. When these analyses were contrasted with the conventional analysis of mean reaction times, the meta-analysis based on reaction times of individual trials yielded a more powerful test of the research hypotheses than the conventional analysis based on mean reaction times for these trials. The advantages and possible limitations of the within-study meta-analysis are discussed.

Color Perception↗

PubMed2005

Fruit and vegetables consumption and gastric cancer: a systematic review and meta-analysis of cohort studies.

Fruit and vegetable intake is widely recognized as protective for gastric cancer occurrence but prospective research challenged this belief. To evaluate the influence of design options in such results we did a meta-analysis of relevant published cohort studies identified from inception to 2004 in PubMed, EMBASE, and LILACS. Random-effects meta-analysis, stratification, and meta-regression were used to pool effects and to analyze the association with type of outcome event and length of follow-up independent of other study characteristics. An inverse association was observed between fruit intake and gastric cancer incidence (relative risk, RR = 0.82; 95% confidence interval, CI = 0.73-0.93) and stronger for follow-up periods of > or = 10 yr (RR = 0.66; 95% CI = 0.52-0.83) but not when the study outcome was death (RR = 1.08; 95% CI = 0.86-1.35). For vegetables, the RR was 0.88 (95% CI = 0.69-1.13) using all incidence studies and 0.71 (95% CI = 0.53-0.94) when considering only those with the longer follow-up. The association observed between vegetable intake and gastric cancer mortality was 1.05 (95% CI = 0.89-1.25). Other study characteristics assessed added no significant contribution to explain heterogeneity. This meta-analysis showed that design options might play a key role in the observed magnitude or the direction of the association between fruit and vegetable intake and gastric cancer.

Adult↗

PubMed2026

Cognitive behavioural therapy-based interventions on stress outcomes in pregnant women: A systematic review and meta-analysis.

BACKGROUND: Stress symptoms were the most common psychological problem in pregnancy. Cognitive behavioural therapy-based interventions are effective for antenatal depression and anxiety symptoms; but there are fewer studies for stress symptoms. OBJECTIVE: The review aims to (1) examine the effectiveness of cognitive behavioural therapy-based interventions in reducing stress outcomes (pregnancy-specific stress symptoms, generic symptoms, and objective stress) in pregnant women, and (2) identify significant moderators affecting the effectiveness of the intervention. DESIGN: Systematic review, meta-analysis, and meta-regression analysis of randomised controlled trials. METHODS: We conducted a three-step search (12 databases, 4 clinical registries, and citation searches) in English and Chinese up to July 24, 2025, by two independent reviewers. Meta-analysis, subgroup, and meta-regression analyses were performed using the R software. Quality assessment and certainty of the evidence were assessed with the Cochrane risk-of-bias tool version 2 and Grading of Recommendations, Assessment, Development, and Evaluation criteria. Publication bias was assessed using funnel plots and Egger's test. RESULTS: We included 20 randomised controlled trials involving a total of 6966 pregnant women from nine countries. Random-effects meta-analyses found that interventions significantly alleviated pregnancy-specific stress symptoms (Hedges' g = -0.84, 95% Confidence Interval, CI -1.42, -0.26, p < .01, I2 = 92.3%), reduced generic stress symptoms (g = -0.64, 95% CI -1.09, -0.20, p < .01, I2 = 87.4%) with median and large effect sizes at post-intervention. No effect was found in lowering cortisol levels (g = -0.99, 95% CI -2.58, -0.60, p = .12, I2 = 84%) at post-intervention. Subgroup and meta-regression analyses indicated that region, age of participants, use of intention-to-treat, missing data management analyses, frequency, modalities, and approaches of interventions, use of different comparators, and attrition rate were significant factors affecting the effectiveness of interventions. Subgroup analyses suggested that the intensity of intervention should be more than once per week using a blended mode among Asian populations. Multivariate meta-regression analyses indicated that both younger age (β = 0.13, p = .02) and a lower attrition rate (β = 0.03, p = .03) significantly improved the effectiveness of interventions. The overall certainty of the evidence was rated as either very low or low. CONCLUSIONS: Cognitive behavioural therapy-based interventions can supplement antenatal care to alleviate pregnancy-specific stress symptoms and generic stress symptoms, particularly in young Asian women. However, the evidence has some uncertainties. These findings should be interpreted with caution due to substantial heterogeneity. Well-designed trials on a large-scale with long-term follow-ups were needed. REGISTRATION: PROSPERO registration ID: CRD420251115913.

Humans↗

PubMed2005

Efficacy of rapid-rate repetitive transcranial magnetic stimulation in the treatment of depression: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature pertaining to rapid-rate repetitive transcranial magnetic stimulation (rTMS) compared with sham therapy for the treatment of a major depressive episode in order to arrive at qualitative and quantitative conclusions about the efficacy of rapid-rate rTMS. METHODS: MEDLINE, the Cochrane Library, the metaRegister of Controlled Trials and abstracts from scientific meetings were searched for the years 1966 until July 2003. The search terms "transcranial magnetic stimulation" and "transcranial magnetic stimulation AND depression" were used. Eighty-seven randomized controlled trials investigating the efficacy of rTMS were referenced on MEDLINE. Nineteen of these involved treatment of a major depressive episode, and these were reviewed. Six met more specific inclusion criteria including the use of rapid-rate stimulation, application to the left dorsolateral prefrontal cortex, evaluation with the 21-item Hamilton Rating Scale for Depression (HAM-D) and use of an intent-to-treat analysis. Scores on the 21-item HAM-D after treatment and standard deviations were extracted from each article for treatment and control subjects. A random-effects model was chosen for the meta-analysis, and the weighted mean difference was used as a summary measure. RESULTS: Six studies that met the inclusion criteria were identified and included in the meta-analysis. Two of these reported a significantly greater improvement in mood symptoms in the treatment versus the sham group. When combined in the meta-analysis, the overall weighted mean difference was -1.1 (95% confidence interval -4.5 to 2.3), and the results of a test for heterogeneity were not significant (chi2(5) = 5.81, p = 0.33). CONCLUSIONS: This meta-analysis suggests that rapid-rate rTMS is no different from sham treatment in major depression; however, the power within these studies to detect a difference was generally low. Randomized controlled trials with sufficient power to detect a clinically meaningful difference are required.

Major Depressive Disorder↗

PubMed2000

Palliative chemotherapy for advanced or metastatic colorectal cancer. Colorectal Meta-analysis Collaboration.

BACKGROUND: Despite the increasing use of palliative chemotherapy for advanced colorectal cancer, there remains uncertainty as to the true effectiveness of this intervention. This review was therefore undertaken to assess the available evidence for the benefit of palliative chemotherapy in this disease. OBJECTIVES: To determine the benefits and harms of palliative chemotherapy in patients with locally advanced or metastatic colorectal cancer. A secondary objective was to investigate outcomes for younger and elderly patients. SEARCH STRATEGY: Trials were identified by computerised and hand searches of the literature, scanning references and contacting investigators. SELECTION CRITERIA: All randomised controlled trials of palliative chemotherapy compared with supportive care alone in patients with advanced or metastatic colorectal cancer. Both randomised and non-randomised studies were considered when searching for data on quality of life, resource use and cost effectiveness of palliative chemotherapy. DATA COLLECTION AND ANALYSIS: Investigators from all eligible studies were asked to supply individual patient data. Meta-analysis was performed using both published data and individual patient data. Studies were grouped according to whether chemotherapy was administered regionally or systemically. MAIN RESULTS: 13 randomised controlled trials representing a total of 1365 randomised patients met the inclusion criteria. Meta-analysis of a subset of trials that provided individual patient data demonstrated that palliative chemotherapy was associated with a 35% (95% CI 24% to 44%) reduction in the risk of death. This translates into an absolute improvement in survival of 16% at both 6 months and 12 months and an improvement in median survival of 3.7 months. The overall quality of evidence relating to treatment toxicity, symptom control and quality of life was poor. REVIEWER'S CONCLUSIONS: Chemotherapy is effective in prolonging time to disease progression and survival in patients with advanced colorectal cancer. The survival benefit may be underestimated by this meta-analysis, as a proportion of patients in the control arms of some trials received chemotherapy. No age related differences were found in the effectiveness of chemotherapy, but elderly patients were under represented in trials. Treatment toxicity and impact upon quality of life and symptom control have been inadequately assessed in the majority of trials and further research is needed to clarify the palliative benefit of chemotherapy.

Adult↗

PubMed2004

Genetic polymorphisms in GSTM1, GSTP1, and GSTT1 and the risk for breast cancer: results from the Shanghai Breast Cancer Study and meta-analysis.

PURPOSE: We studied the relation of breast cancer to common deletion mutations in GSTM1 and GSTT1 and the functional Ile(105)Val polymorphism in GSTP1 in a large, population-based case-control study conducted in China and performed a meta-analysis to summarize the literature. EXPERIMENTAL DESIGN: In the case-control study, a total of 1144 breast cancer cases and 1221 community controls were genotyped for GSTM1, GSTP1, and GSTT1 using PCR-based methods. Associations of genotypes and breast cancer were evaluated in logistic regression models. Meta-analysis odds ratios (ORs) were estimated using a fixed effects model. RESULTS: In the case-control study, associations were null for GSTM1 [age-adjusted OR 0.97, 95% confidence interval (CI): 0.82-1.14] and GSTT1 (OR 0.97, 95% CI: 0.83-1.15). A significant increase in risk was observed among homozygotes for the variant Ile(105)Val polymorphism (OR 1.92, 95% CI: 1.21-3.04). No combined effects of GSTM1, GSTP1, and GSTT1 genotypes or interactions with potential effect modifiers were detected. All results were similar in pre- and postmenopausal women and for early versus advanced stage breast cancer. The meta-analysis, based predominantly on Caucasian women, supported null results for the homozygous deletion variant in GSTM1 (summary OR 1.05; combining 19 studies) and GSTT1 (summary OR 1.11; 15 studies). Meta-analysis results for the homozygous GSTP1 variant indicated no overall association (summary OR 1.04; 10 studies), although results varied significantly across studies (P = 0.009). CONCLUSIONS: This large case-control study provides strong support for earlier studies showing no overall association of the GSTM1 and GSTT1 deletion polymorphisms with breast cancer risk. The GSTP1 variant may be relevant to breast cancer risk in Asian populations.

Acyltransferases↗

PubMed1997

Standardization of terminology in meta-analysis: a proposal for working definitions.

In this paper we present a brief overview of the growing concern to standardize definitions and terminology in meta-analysis. This tool has become inescapable in both drug research and therapeutic evaluation. The performed and published meta-analyses are increasing, as well as the variation in the meaning of the terms used in meta-analysis. In the second part of the paper we propose glossary of the most common terms used in reports of meta-analyses. The glossary has been written by only one group of scientists, the definitions are therefore proposed to the scientific community as working definitions, to be subject to reactions from leaders in meta-analysis.

Clinical Trials as Topic↗

PubMed1995

Use of cumulative meta-analysis in the design, monitoring, and final analysis of a clinical trial: a case study.

From 1983 to 1987, the Department of Veterans Affairs (DVA) Cooperative Studies Program (CSP) conducted a multicenter clinical trial (CSP #207) to determine whether four different antiplatelet regimens compared to placebo could prevent the occlusion of grafts following coronary artery bypass surgery. The study showed that all of the active regimens tended to be better than placebo and that the three regimens containing aspirin were statistically significantly better. A cumulative meta-analysis of 12 trials performed shortly before the end of CSP #207 raised the issue as to whether the meta-analysis, if done earlier, would have changed the conduct of the trial. At the start of the planning period, one trail of size n = 37 had been published with a nonsignificant odds ratio (OR) of 0.74 (95% CI: 0.18, 3.12). At the time that CSP # 207 was approved by the DVA Cooperative Studies Evaluation Committee, two trials had been published (cumulative n = 150, OR = 0.44, 95% CI 0.19, 0.99). At the time patient intake started, five trials showed cumulative n = 769, OR = 0.42, 95% CI = 0.26, 0.68. Although the first 6-month CSP #207 progress report showed no treatment effect, by the time of the 12-month review by the Data Monitoring Board (DMB) a trend was developing in favor of active treatment. If the results of the meta-analysis had been available to the DMB at that time, conceivably the Board would have recommended stopping the placebo arm because of a convincing treatment effect based on the totality of the evidence. Cumulative meta-analysis could be useful as an adjunct in the planning, conduct, and final analysis of a clinical trial. It could also be used as one piece of evidence in the monitoring of the ongoing phase of a trial.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2003

Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis.

BACKGROUND: In postmenopausal women, a history of any fracture is an important risk factor for a future hip fracture. Whether similar findings apply to aging men remains to be established. We conducted a systematic review and meta-analysis of the literature to compare men and women with respect to the relative risk of hip fracture after a wrist or spine fracture. METHODS: Studies published in full from January 1982 through September 2002 in English, French, or German were identified from the PubMed database and from reference lists of retrieved articles. We included cohort studies that reported fractures associated with minimal trauma of the wrist or spine as a risk factor for a subsequent hip fracture among (white) women and men who were fifty years old or older. Data were extracted by two independent reviewers and were checked for accuracy in a second review. Differences in assessments were resolved by consensus of the two reviewers. RESULTS: Nine cohort studies were included in this meta-analysis: five studies were conducted in the United States and four, in Europe. After homogeneity of association was demonstrated across all studies, a fixed-effects meta-analysis was used to calculate pooled relative risks with 95% confidence intervals. Among postmenopausal women, the relative risks for a future fracture of the hip after a fracture of the wrist or spine were 1.53 (95% confidence interval, 1.34 to 1.74; p < 0.001) and 2.20 (95% confidence interval, 1.92 to 2.51; p < 0.001), respectively. In older men, these relative risks were 3.26 (95% confidence interval, 2.08 to 5.11; p < 0.001) and 3.54 (95% confidence interval, 2.01 to 6.23; p < 0.001), respectively. Fractures of the distal part of the radius increased the relative risk of hip fracture significantly more in men than in women (p = 0.002). The impact of a spine fracture, conversely, did not differ between genders (p = 0.11). Sensitivity analyses with use of random-effects methodology confirmed these findings to be robust. CONCLUSIONS: This meta-analysis suggests that a previous spine fracture has an equally important impact on the risk of a subsequent hip fracture in both genders. The prospective association between a Colles fracture and a subsequent hip fracture, however, is significantly stronger among men than among postmenopausal women. Men with a Colles fracture are at high risk for a future hip fracture and should be evaluated as candidates for preventive measures.

Age Factors↗

PubMed1991

A meta-analysis of life course variation in drinking.

Meta-analysis combines results from multiple longitudinal studies to describe life course variation by age and sex for quantity of drinking per typical occasion (20 studies) and frequency of drinking during one month (27 studies). There is cross-study heterogeneity for the Time 1 means of the drinking variables blocking for age and sex. Age distributions for the Time 1 means are similar by gender within nations; in the aggregate, males exceed females in the magnitude of drinking. Dramatic shifts in the standardized mean difference (M2-M1) occur among the young; greater homogeneity and moderate change (declines) occur later in life. Implicated in improving cross-study homogeneity for M2-M1 among the young are interval between measurements, nation, Time 1 per capita consumption (PCC), difference in PCC and the Time 1 mean. Lower unstandardized regression coefficients are found for quantity among youth, but are not consistently homogeneous within nations; the association for frequency becomes increasingly stable with increasing age. Nation and interval are implicated in improving homogeneity. Decline in quantity occurs among the old. M2-M1 produces homogeneously higher regressions for groups of the young who increase quantity v. those who do not. Linkage of the group-level and individual-level findings is discussed.

Adolescent↗

PubMed2006

Systematic review and meta-analysis: levofloxacin-based rescue regimens after Helicobacter pylori treatment failure.

BACKGROUND: A quadruple therapy has been generally recommended as rescue regimen for Helicobacter pylori eradication failures. AIMS: To systematically review the efficacy and tolerance of levofloxacin-based rescue regimens, and to conduct a meta-analysis of studies comparing these regimens with quadruple therapy for H. pylori eradication failures. METHODS: Selection of studies -- levofloxacin-based rescue regimens. For the meta-analysis, randomized-controlled trials comparing levofloxacin-based and quadruple regimens. Search strategy -- electronic and manual. Assessment of study quality -- independently by two reviewers. Data synthesis --'intention-to-treat' eradication rate. RESULTS: Mean eradication rate with levofloxacin-based regimens was 80%. Ten-day regimens were more effective than 7-day combinations (81% vs. 73%; P < 0.01). The meta-analysis showed better results with levofloxacin than with the quadruple combination (81% vs. 70%; OR = 1.80; 95% CI = 0.94-3.46). This difference reached statistical significance and heterogeneity markedly decreased when a single outlier study was excluded or when only high-quality studies were considered. Meta-analysis showed less adverse effects with levofloxacin than with quadruple regimen, both overall (19% vs. 44%; OR = 0.27; 95% CI = 0.16-0.46) and regarding severe adverse effects (0.8% vs. 8.4%; OR = 0.20; 95% CI =0.06-0.67). CONCLUSIONS: After H. pylori eradication failure, levofloxacin-based rescue regimen is more effective and better tolerated than the generally recommended quadruple therapy. A 10-day combination of levofloxacin-amoxicillin-proton pump inhibitor constitutes an encouraging second-line alternative.

Antacids↗

PubMed1991

Mean and range of the ambulatory pressure in normotensive subjects from a meta-analysis of 23 studies.

To perform a meta-analysis of published reports in an attempt to determine the mean and range of normal ambulatory blood pressure (BP), 23 studies including a total of 3,476 normal subjects were reviewed. Most studies were compatible with a mean 24-hour BP in the range of 115 to 120/70 to 75 mm Hg, a mean daytime BP of 120 to 125/75 to 80 mm Hg, and a mean nighttime BP of 105 to 110/60 to 65 mm Hg. With weighting for the number of subjects included in the individual studies, the 24-hour BP averaged 118/72 mm Hg, the daytime BP 123/76 mm Hg, and the nighttime BP 106/64 mm Hg. The night/day pressure ratio averaged 0.87 for systolic and 0.83 for diastolic BP, with ranges across the individual studies from 0.79 to 0.92 and from 0.75 to 0.90, respectively. If the mean +/- 2 standard deviation interval in the various studies was considered normal, the range of normality was on average 97 to 139/57 to 87 mm Hg for the 24-hour BP, 101 to 146/61 to 91 mm Hg for the daytime BP, and 86 to 127/48 to 79 mm Hg for the nighttime BP. Until the results of prospective studies on the relation between the ambulatory BP and the incidence of cardiovascular morbidity and mortality become available, the aforementioned intervals, which summarize the experience of 23 investigators, could serve as a temporary reference for clinical practice.

Adolescent↗

PubMed2006

Reanalysis of the Grønnerød (2003) Rorschach temporal stability meta-analysis data set.

I reanalyzed the Grønnerød (2003) Rorschach temporal stability meta-analysis data with a theoretically driven hierarchical regression analysis. I also examined the intrarater reliability of initial coding decisions and verified their consistency. In the new regression analyses, retest period strengthened its influence on stability, whereas methodological factors showed a tendency toward influence. The new results are more in line with the results from Grønnerød's (2004) psychotherapy change meta-analysis results.

Humans↗

PubMed2005

Effects of walking-only interventions on bone mineral density at various skeletal sites: a meta-analysis.

BACKGROUND AND PURPOSE: Osteoporosis, a common disease in postmenopausal women and the elderly, is associated with decreases in bone mineral density (BMD) and fractures. As weight-bearing activity such as walking has the potential to maintain or increase BMD, I sought in this meta-analysis to mathematically consolidate research on the effects of walking interventions on BMD. METHODS: A literature search for studies examining the effect of walking on BMD in postmenopausal women and men and women aged 50 years and older was conducted. Search strategies included online literature searches, hand-searches of journals, and examination of the reference lists of articles selected for inclusion. Effect sizes were calculated for each article selected for inclusion and a meta-analysis was conducted for these articles. RESULTS: Ten articles met the inclusion criteria for the meta-analysis. Walking had a significant (P < or = .03) positive effect (.32) on lumbar BMD but not on the femur or the calcaneus. DISCUSSION AND CONCLUSION: The results of this meta-analysis do not suggest that walking interventions alone will limit demineralization at all skeletal sites. Perhaps other forms of exercise in addition to walking should be incorporated into training regimens for patients at risk for osteoporosis.

Aged↗

PubMed2000

Meta-analysis of clinical trials of permixon in the treatment of symptomatic benign prostatic hyperplasia.

OBJECTIVES: Permixon is a compound extracted from the fruit of the American dwarf palm tree, Serenoa repens. Controversy regarding the use of phytotherapeutic agents in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is significant. We analyzed all available clinical trial data of the Permixon preparation to determine its clinical efficacy compared with placebo. METHODS: All published clinical trial data on Permixon (11 randomized clinical trials and 2 open label trials), involving 2859 patients, were used. These trials were disparate in size (from 22 to 592 patients) and duration (from 21 to 180 days). Peak urinary flow rate and nocturia were the two common end points. The statistical analysis was based on a random effects meta-analysis. RESULTS: The average +/- SE placebo effect on the peak urinary flow rate was an increase of 0.51 +/- 0.51 mL/s. The estimated effect of Permixon was a further increase of 2.20 +/- 0.51 mL/s (P <0.001). Placebo was associated with a reduction in the mean number +/- SE of nocturnal urinations of 0.69 +/- 0.15. A further reduction of 0.50 +/- 0.01 episodes of urination (P <0.001) occurred that was attributable to Permixon. Some heterogeneity was found among the studies. Treatment duration did not appear to impact either of these effects. CONCLUSIONS: This meta-analysis of all available published trials of Permixon in the treatment of men with benign prostatic hyperplasia revealed a significant improvement in peak flow rate and reduction in nocturia greater than with placebo.

Androgen Antagonists↗

PubMed2002

Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs.

When a meta-analysis on results from experimental studies is conducted, differences in the study design must be taken into consideration. A method for combining results across independent-groups and repeated measures designs is described, and the conditions under which such an analysis is appropriate are discussed. Combining results across designs requires that (a) all effect sizes be transformed into a common metric, (b) effect sizes from each design estimate the same treatment effect, and (c) meta-analysis procedures use design-specific estimates of sampling variance to reflect the precision of the effect size estimates.

Humans↗

PubMed2005

A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials.

Both regional anesthesia and general anesthesia have been proposed to provide optimal ambulatory anesthesia. We searched MEDLINE and other databases for randomized controlled trials comparing regional anesthesia and general anesthesia in ambulatory surgery patients for meta-analysis. Only major conduction blocks were considered to be regional anesthesia. Regional anesthesia was further separated into central neuraxial block and peripheral nerve block. Fifteen (1003 patients) and 7 (359 patients) trials for central neuraxial block and peripheral nerve block were included in the meta-analysis. Both central neuraxial block and peripheral nerve block were associated with increased induction time, reduced pain scores, and decreased need for postanesthesia care unit analgesics. However, central neuraxial block was not associated with decreased postanesthesia care unit bypass or time or reduced nausea despite reduced analgesics, and it was associated with a 35-min increase in total ambulatory surgery unit time. In contrast, peripheral nerve block was associated with decreased postanesthesia care unit need and decreased nausea but, again, not with decreased ambulatory surgery unit time. This meta-analysis indicates potential advantages for regional anesthesia, such as decreased postanesthesia care unit use, nausea, and postoperative pain. Although these factors have been proposed to reduce ambulatory surgery unit stay, neither central neuraxial block nor peripheral nerve block were associated with reduced ambulatory surgery unit time. Other factors, such as unsuitable discharge criteria and limitations of meta-analysis, may explain this discrepancy.

Ambulatory Surgical Procedures↗