Anesth Pain Med > Volume 18(2); 2023 > Article |
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FUNDING
This study was supported by the Vice Chancellor for Research and Technology of Shiraz University of Medical Sciences (code: 21331). The funder had no role in the study design, analysis, decision to publish, or manuscript preparation.
DATA AVAILABILITY STATEMENT
The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
AUTHOR CONTRIBUTIONS
Conceptualization: Reza Barati-Boldaji, Sara Shojaei-Zarghani, Manoosh Mehrabi, Afshin Amini, Ali Reza Safarpour. Data curation: Reza Barati-Boldaji, Ali Reza Safarpour. Formal analysis: Reza Barati-Boldaji, Ali Reza Safarpour. Funding acquisition: Ali Reza Safarpour. Methodology: Reza Barati-Boldaji, Sara Shojaei-Zarghani, Manoosh Mehrabi, Afshin Amini, Ali Reza Safarpour. Project administration: Ali Reza Safarpour. Visualization: Ali Reza Safarpour. Writing - original draft: Reza Barati-Boldaji, Sara Shojaei-Zarghani. Writing - review & editing: Manoosh Mehrabi, Afshin Amini, Ali Reza Safarpour. Investigation: Ali Reza Safarpour. Resources: Ali Reza Safarpour. Software: Ali Reza Safarpour. Supervision: Ali Reza Safarpour. Validation: Ali Reza Safarpour.
Study | Location | Sex | Age (yr) | Study population | Number of participants (control group, intervention group) | Time of pain assessment following aminophylline/theophylline (h) | Dosage of aminophylline/theophylline | Control group | Outcome | Risk of bias |
---|---|---|---|---|---|---|---|---|---|---|
Ergün et al., 2008 [31] | Turkey | M/F | 31.88 | Patients who had undergone lumbar puncture for diagnosis or epidural anesthesia and subsequently developed PDPH | 16, 17 | 4 | Theophylline, 200 mg, iv | 5% dextrose | VAS | High |
Wu et al., 2018 [1] | China | M/F | 36.5 | 64, 62 | 0.5 | Aminophylline, 50 mg, iv once daily for 2 consecutive days | Normal saline | VAS | Low | |
Patients with PDPH | 1 | 2 | ||||||||
8 | ||||||||||
12 | ||||||||||
Sakr et al., 2018 [29] | Egypt | M/F | 26.23 | 30, 30 | 1 | Paracetamol | NRS | Unclear | ||
Patient with lower extremity and lower abdominal surgery under spinal anesthesia | 7 | Theophylline, 250 mg orally/8 hours + Paracetamol 500 mg/8 hours orally | ||||||||
13 | ||||||||||
19 | ||||||||||
Sen et al., 2014 [30] | India | M/F | 30 | Patients under spinal anesthesia | 20, 20 | Theophylline, 400 mg orally | Conservative treatment* | VAS | High | |
8 | ||||||||||
16 | ||||||||||
24 | ||||||||||
Fawaz et al., 2021 [24] | Egypt | M/F | 32.77 | Patients with PDPH | 35, 35 | Aminophylline, 250 mg, iv | 1 g paracetamol, iv | VAS | Low | |
2 | ||||||||||
6 | ||||||||||
12 | ||||||||||
Mahoori et al., 2013 [32] | Iran | M/F | 40.06 | Patients with PDPH | 30, 30 | 2 | Theophylline, tablet 250 mg three times per day | Acetaminophen 500 mg three times per day | VAS | High |
6 | ||||||||||
12 |
Study | Location | Sex | Age (yr) | Study population | Number of participants (control group, intervention group) | Time of pain assessment following aminophylline (h) | Dosage of aminophylline | Control group | Outcome | Risk of bias |
---|---|---|---|---|---|---|---|---|---|---|
Dehghanpisheh et al., 2019 [23] | Iran | F | 30 | Women undergoing cesarean surgery under spinal anesthesia | 100, 100 | 1 mg/kg iv | Normal saline | NRS | Low | |
Total | ||||||||||
24 | ||||||||||
48 | ||||||||||
72 | ||||||||||
Ghanei et al., 2015 [28] | Iran | F | 30 | Women undergoing cesarean surgery under spinal anesthesia | 100, 100 | 2 mg/kg iv combined with conventional therapy | Conventional therapy* | VAS | Low | |
6 to 12 | ||||||||||
12 to 24 | ||||||||||
⏵24 | ||||||||||
Naghibi et al., 2014 [25] | Iran | M/F | 45.7 | Patients undergoing lower extremity surgery | 35, 34 | 6 to 48 | 1.5 mg/kg iv | Normal saline | VAS | Low |
Yang et al., 2019 [10] | China | F | 27.2 | Women undergoing cesarean surgery under combined spinal epidural anesthesia | 58, 59 | 250 mg of aminophylline oral | Normal saline | NR | Low | |
24 | ||||||||||
48 | ||||||||||
72 | ||||||||||
Mohamed et al., 2021 [27] | Egypt | F | 25 | Women undergoing cesarean surgery under spinal anesthesia | 52, 52 | 100 μg/kg/min) diluted in 50 ml normal saline (0.9%) infusion for 30 minutes | Normal saline | VAS | Unclear | |
24 | ||||||||||
48 | ||||||||||
72 | ||||||||||
Sadeghi et al., 2012 [26] | Iran | F | 26.11 | Women undergoing cesarean surgery under spinal anesthesia | 60, 60 | 1 mg/kg iv | NR | VAS | Unclear | |
24 | ||||||||||
48 | ||||||||||
Hasannasab et al., 2018 [33] | Iran | F | 28.3 | Women undergoing cesarean surgery under spinal anesthesia | 70, 70 | 1 mg/kg iv | Normal saline | VAS | Low | |
8 | ||||||||||
24 | ||||||||||
48 | ||||||||||
72 | ||||||||||
Jabalameli et al., 2019 [11] | Iran | M/F | 35 | Patients undergoing lower extremity surgery | 30, 30 | 1.5 mg/kg iv | Normal saline | VAS | Low | |
6 | ||||||||||
12 | ||||||||||
18 | ||||||||||
24 | ||||||||||
48 | ||||||||||
72 | ||||||||||
Jabalameli et al., 2016 [34] | Iran | M/F | 30.5 | Patients undergoing lower extremity surgery | 34, 34 | 1.5 mg/kg iv | Normal saline | VAS | Unclear | |
6 | ||||||||||
12 | ||||||||||
18 | ||||||||||
24 | ||||||||||
48 | ||||||||||
72 |
Variables | Number of studies | SMD | 95% CI | P value within subgroup | I² (%) | P value for heterogeneity | P value for subgroup difference |
---|---|---|---|---|---|---|---|
Age (yr) | |||||||
< 32 | 3 | -1.87 | -2.37 to -1.36 | < 0.001 | 30.3 | 0.230 | 0.480 |
≥ 32 | 3 | -1.44 | -2.52 to -0.36 | 0.009 | 92.9 | < 0.001 | |
Type of control group | |||||||
Placebo | 2 | -2.51 | -2.93 to -2.09 | < 0.001 | 0.0 | 0.940 | < 0.001 |
Conventional therapy* | 4 | -1.25 | -1.68 to -0.81 | < 0.001 | 56.2 | 0.070 | |
Time of VAS score measurement | |||||||
≤ 12 h | 3 | -1.36 | -2.19 to -0.53 | 0.001 | 81.4 | 0.005 | 0.230 |
> 12 wk | 3 | -1.98 | -2.59 to -1.37 | < 0.001 | 69.1 | 0.030 | |
Route of aminophylline administration | |||||||
Intravenous | 3 | -2 | -3.07 to -0.92 | < 0.001 | 89.8 | < 0.001 | 0.290 |
Oral | 3 | -1.34 | -1.96 to -0.72 | < 0.001 | 68.0 | 0.040 | |
Type of intervention | |||||||
Theophylline | 4 | -1.59 | -2.28 to -0.91 | < 0.001 | 76.0 | 0.006 | 0.820 |
Aminophylline | 2 | -1.77 | -3.22 to -0.33 | 0.010 | 94.0 | < 0.001 | |
Quality of studies | |||||||
Low | 3 | -1.63 | -2.64 to -0.62 | 0.002 | 83.3 | 0.002 | 0.480 |
Moderate/high | 3 | -1.72 | -2.61 to -0.83 | < 0.001 | 88.9 | < 0.001 |