A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain.

We searched MEDLINE, Embase, CINAHL, AMED and CENTRAL databases until December 2014 and included 133 randomised controlled trials of peri-operative gabapentin vs placebo. Gabapentin reduced mean (95% CI) 24-h morphine-equivalent consumption by 8.44 (7.26-9.62) mg, p < 0.001, whereas more specific reductions in morphine equivalents were predicted (R(2)  = 90%, p < 0.001) by the meta-regression equation: 3.73 + (-0.378 × control morphine consumption (mg)) + (-0.0023 × gabapentin dose (mg)) + (-1.917 × anaesthetic type), where 'anaesthetic type' is '1' for general anaesthesia and '0' for spinal anaesthesia. The type of surgery was not independently associated with gabapentin effect. Gabapentin reduced postoperative pain scores on a 10-point scale at 1 h, 2 h, 6 h, 12 h and 24 h by a mean (95% CI) of: 1.68 (1.35-2.01); 1.21 (0.88-1.55); 1.28 (0.98-1.57); 1.12 (0.91-1.33); and 0.71 (0.56-0.87), respectively, p < 0.001 for all. The risk ratios (95% CI) for postoperative nausea, vomiting, pruritus and sedation with gabapentin were: 0.78 (0.69-0.87), 0.67 (0.59-0.76), 0.64 (0.51-0.80) and 1.18 (1.09-1.28), respectively, p < 0.001 for all. Gabapentin reduced pre-operative anxiety and increased patient satisfaction on a 10-point scale by a mean (95% CI) of 1.52 (0.78-2.26) points and 0.89 (0.22-1.57) points, p < 0.001 and p = 0.01, respectively. All the effects of gabapentin may have been overestimated by statistically significant small study effects.

[U-shaped chisel to cut the orbital roof: technical note]. / Cisel em U para a secção do teto da órbita. Nota técnica.

We describe a new U-shaped chisel whose cutting edge allows for a precise and safer cutting of the orbital roof in the frontoorbital approach.

[An en bloc cranio-orbitozygomatic approach: surgical technique and results]. / Acesso crânio-orbitozigomático em flape único. Técnica cirúrgica e resultados.

An en bloc cranio-orbitozygomatic approach is described. This technique was applied in seven patients (five basilar artery aneurysms, a trigeminal neuroma, a meningioma of the lesser sphenoid wing). The follow-up period ranged from 3 to 50 months. The patients were retrospectively analyzed from the cosmetic point of view, and submitted to computerized tomography with three dimensional and multiplanar reconstructions. The access provided a wider operative field with a shorter distance to the pathology and possibility of increased angulation of the microscope. The aneurysms could be clipped and the tumors completely removed in all cases. A frontalis muscle paralysis occurred in two cases, as well as a temporalis muscle atrophy in another two patients. There were no enophthalmos or bone flap displacements. The surgical technique is simple and do not require drills, electric saws and mini-plates.

Effect of long-term glycemic control on cognitive function.

OBJECTIVE: To investigate the relationship between recurrent hypoglycemia and cognitive impairment in insulin-dependent diabetic patients. RESEARCH DESIGN AND METHODS: Seventy patients who were diagnosed as diabetic at age 18 years or older, were under 55 years old, and had no condition likely to affect cognitive abilities were recruited from a diabetic register. Patients were interviewed to obtain information on the frequency of major and minor hypoglycemia. Their cognitive abilities were assessed on tests of premorbid intelligence, current intelligence, reaction time, concentration, memory, and information processing. RESULTS: There was a significant correlation between the apparent decline in intelligence, expressed as the discrepancy between the estimated premorbid and the actual performance intelligence quotient, and the frequency of major hypoglycemic attacks (rs = -0.30; P < 0.01). Comparison of patients with and without recurrent hypoglycemia showed few significant differences in cognitive ability. CONCLUSIONS: Results support previous work that suggests that major hypoglycemic attacks have a significant effect on some aspects of cognitive function, but the clinical importance of this finding remains to be determined.