Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados

Topics

Temas

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Forest plot of comparison: 1 Hyaluronidase versus control, outcome: 1.1 Intraoperative pain (measured by analogue rating scales; reported continuous).
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Hyaluronidase versus control, outcome: 1.1 Intraoperative pain (measured by analogue rating scales; reported continuous).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Forest plot of comparison: 1 Hyaluronidase versus control, outcome: 1.2 Intraoperative pain (measured by analogue rating scales; reported dichotomous).
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Hyaluronidase versus control, outcome: 1.2 Intraoperative pain (measured by analogue rating scales; reported dichotomous).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Hyaluronidase versus control, Outcome 1 Intraoperative pain (reported continuous).
Figuras y tablas -
Analysis 1.1

Comparison 1 Hyaluronidase versus control, Outcome 1 Intraoperative pain (reported continuous).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Hyaluronidase versus control, Outcome 2 Intraoperative pain (reported dichotomous).
Figuras y tablas -
Analysis 1.2

Comparison 1 Hyaluronidase versus control, Outcome 2 Intraoperative pain (reported dichotomous).

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults

Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults

Patients or population: adults (aged ≥ 18 years) undergoing ophthalmic surgery under local anaesthetic eye blocks.
Setting: hospitals in the UK (4), Germany (1), Brazil (1) and Iran (1).
Intervention: local anaesthetic eye blocks containing hyaluronidase.
Comparison: local anaesthetic eye blocks containing no hyaluronidase.

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no hyaluronidase

Risk with hyaluronidase

Intraoperative pain (reported dichotomous)
assessed with: analogue rating scales
No follow‐up ‐ measured on day of surgery.

RR 0.83
(0.48 to 1.42)

289
(4 RCTs)

⊕⊕⊝⊝
Low1,2

‐

301 per 1000

250 per 1000
(145 to 428)

Intraoperative pain (reported continuous)
assessed with: analogue rating scales
No follow‐up ‐ measured on day of surgery.

3 trials looked at effect of hyaluronidase on reduction of intraoperative pain measured by rating scales. Results were reported as continuous data. 2 studies did not provide the SMD, which measures the effect in a clinical setting, the results could not be meta‐analysed and hence were reported narratively (Khandwala 2008; Rowley 2000). Among the 3 trials covering 211 participants (Khandwala 2008: Mean difference 0.70; Rowley 2000: Mean difference 0.31; Sedghipour 2012: Mean difference ‐1.10), only the Sedghipour study with 42 participants, which is a high quality study, showed a statistically significant (at the 5 % level) reduction in pain in the hyaluronidase group (P = 0.04). The remaining 2 studies with 169 participants showed no statistically significant (at the 5 % level) reduction of pain intraoperatively with hyaluronidase (Khandwala 2008: P = 0.5; Rowley 2000: n.s). These studies were also of high quality and low risk of bias. Khandwala and colleagues had an unclear attrition bias as 1/10 participants in the treatment group was dropped after randomization with no clear explanation.

‐

211
(3 RCTs)

⊕⊕⊝⊝
Low3

‐

Incidence of harm

None of the studies reported harms in relation to hyaluronidase.

‐

(0 studies)

‐

‐

Participant satisfaction
assessed with: scoring system
No follow‐up ‐ measured on day of surgery.

Significantly better satisfaction in these well designed studies with low risk of bias (Remy 2008; Sedghipour 2012). The studies included 122 participants and showed higher satisfaction scores in the treatment group (P < 0.05).

‐

122
(2 RCTs)

⊕⊕⊕⊝
Moderate4

‐

Surgical satisfaction
assessed with: scoring system
No follow‐up ‐ measured on the day of surgery.

Surgical satisfaction was reportedly superior with hyaluronidase in the larger 2 studies (Remy 2008: P < 0.001; Sedghipour 2012: P = 0.02) and not significantly different in 1 small study (Khandwala 2008: P = 0.96).

‐

141
(3 RCTs)

⊕⊕⊕⊝
Moderate4

‐

Economic outcomes or cost calculations

None of the included studies reported economic outcomes or cost calculations

‐

(0 RCTs)

‐

‐

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; n.s: not statistically significant; RCT: randomized controlled trial; RR: risk ratio; SMD: standardized mean difference.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

1Downgraded one level due to marked heterogeneity with a calculated I2 > 50%.

2Downgraded one level for imprecision due to wide 95% confidence intervals, reflecting uncertainty in the direction of effect estimate.

3Downgraded one level for imprecision and inconsistency in measurement, lack of data and small sample size.

4Downgraded one level because of imprecision secondary to small sample size.

Figuras y tablas -
Summary of findings for the main comparison. Use of hyaluronidase as an adjunct to local anaesthetic eye blocks to reduce intraoperative pain in adults
Ir a la tabla de la revisión
Comparison 1. Hyaluronidase versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intraoperative pain (reported continuous) Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2 Intraoperative pain (reported dichotomous) Show forest plot

4

289

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.48, 1.42]
Figuras y tablas -
Comparison 1. Hyaluronidase versus control
Ir a la tabla de la revisión