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  • Dexmedetomidine reduces perioperative opioid consumption and postoperative pain intensity in neurosurgery: a meta-analysis
    J Neurosurg Anesthesiol. 2018;30(2):146-155

    Bottom Line

    The evidence suggests that dexmedetomidine reduces intraoperative fentanyl consumption, postoperative opioid consumption, pain intensity, postoperative nausea and vomiting, shivering incidences, extubation time in comparison with the control group in patients undergoing intracranial surgery. However, the difference in hypotension and tachycardia is not significant between both the groups. A limited database search, no additional attempts to locate further studies and the lack of a search strategy means that some eligible studies may have been missed. Appropriate attempts were not made to explore the possible sources of heterogeneity. Publication bias was planned, but not assessed. Further large samples of randomised controlled trials are needed to address the present review question.

    Risk of Bias Assessment

    A limited range of databases were searched in the study selection process. There were no additional attempts made to locate further studies. The search terms were provided, but a full search strategy was not reported. The authors acknowledged sources of heterogeneity due to different dexmedetomidine doses, different administration methods, different surgical procedures, and different postoperative analgesia protocols in the limitations section. Publication bias assessment was planned, but not done.
  • Exercise for the prevention of low back and pelvic girdle pain in pregnancy: a meta-analysis of randomized controlled trials
    Eur J Pain. 2018;22:19-27

    Bottom Line

    The current evidence suggests that exercise during pregnancy has a modest effect in reducing lower back pain and associated sick leave, but there is no clear evidence for an effect on pelvic girdle pain. However, these results must be interpreted with caution, since relevant studies may have been missed, and error and bias may have been introduced. Further high-quality trials are needed to fully address the review question.

    Risk of Bias Assessment

    Only a single author screened the main database search results, which may have led to relevant studies being missed. No information was provided on how many reviewers were involved in the data extraction, which may indicate error and bias.
  • Simplified guideline for prescribing medical cannabinoids in primary care
    Can Fam Physician. 2018;64(2):111-20

    Bottom Line

    This guideline presents clear recommendations, however, there are some concerns regarding the lack of clear links to supporting evidence. In addition, implementation issues do not appear to have been considered.
  • The assessment of pain in older people: UK national guidelines
    Age Ageing. 2018;47(Suppl 1):i1-22

    Bottom Line

    This guideline appears to have been developed using rigorous methodology, however, the presentation of recommendations is weak, there is a lack of information about patient/public consultation, and implementation issues do not appear to have been considered.
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