By Martin Tram?r
This paintings discusses the method and to be had proof from systematic stories at the present top perform in anaesthesia and analgesia. the 1st version is outfitted upon during this completely revised and up-to-date textual content. Contributions are from said international professionals on systematic evaluation within the forte. The unfastened entry site keeps to supply further aspect at the literature.
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Anaesth Intensive Care 1996;24: 685–93. 15. MacMahon S, Collins R. Reliable assessment of the effects of treatment on mortality and major morbidity, II: observational studies. Lancet 2001;357:455–62. 16. Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321–33. 19 EVIDENCE-BASED RESOURCE IN ANAESTHESIA AND ANALGESIA 17. Park WY, Thompson JS, Lee KK.
5. For only three smaller trials was there a large effect of neuraxial blockade, and in these three there was an extraordinarily high death rate with control of over 15%. For six other trials in which the death rate with control was below 15%, the death rates with neuraxial blockade and control were about the same. Over all 141 trials there was a protective effect of neuraxial blockade (NNT 98 to prevent one death). Excluding trials with death rates over 10%, the effect of neuraxial blockade was very small, reducing the death rate from 2·1% in controls who did not receive neuraxial blockade to 1·8% in 136 trials with 94% of the patients.
While there is an important place for this sort of study, to be clinically relevant studies have to be much larger than the traditional 40 patients per group, perhaps 10 times larger. This is also a problem with studies of postoperative nausea and vomiting (PONV), where similar patients having similar interventions can have PONV rates that vary between 0% and 100%, in part because they are tiny. No such trial can be of any value, except as a marketing exercise, which so many are. Outcomes Systematic reviews can help us focus on what we measure in clinical trials.