Table 1.
Main characteristics of RCTs included in the meta-analysis
| Study (Year) | Country | Sample Size | No. of Pts (BG/PG) | Gender (M/F) | Age (yr) | Doses (mg) | Concentration (%) | Type of anaesthesia | Epinephrine | Surgery time (min) | Injection time | Tourniquet | Study design | OCEBM (R/C/B/F) | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BG | PG | ||||||||||||||
| Aasbo (1996) | Norway | 54 | 27/27 | 34/20 | 39 | 50 | 0.25 | GA | No | 32 ± 20 | 28 ± 12 | 8 min before RT | Yes | Double-blind | 5 (1/1/2/1) |
| RCT | |||||||||||||||
| Alagol (2005) | Turkey | 50 | 25/25 | 33/17 | 51.7 | 100 | 0.5 | GA | No | 83.8 ± 13.9 | 79.9 ± 10.6 | 15 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Ates (1994) | Turkey | 20 | 10/10 | 17/3 | 24.8 | 50 | 0.5 | SA | No | NA | 5 min before RT | Yes | Double-blind | 5(1/1/2/1) | |
| RCT | |||||||||||||||
| Bjornsson (1994) | Sweden | 38 | 19/19 | 27/11 | 32 | 50 | 0.25 | GA | No | 27.3 ± 12 | 24.7 ± 10 | 5-10 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Calmet (2004) | Spain | 40 | 20/20 | NA | NA | 25 | 0.25 | GA | No | NA | Before RT | Yes | Double-blind | 5(1/1/2/1) | |
| RCT | |||||||||||||||
| Campo (2012) | Netherlands | 190 | 94/96 | 85/105 | 50.1 | 50 | 0.5 | GA | No | 17 (8–40) | 16 (4–36) | Before RT | Yes | Double-blind | 7(2/2/2/1) |
| RCT | |||||||||||||||
| Cepeda (1997) | U.K. | 56 | 27/29 | 37/19 | 37.6 | 100 | 0.5 | GA | Yes | 51.5 ± 19.4 | 53.0 ± 19.8 | 5 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Cook (1997) | Turkey | 42 | 21/21 | 36/6 | 34.5 | 100 | 0.25 | GA | No | NA | 10 min before RT | Yes | Double-blind | 7(2/2/2/1) | |
| RCT | |||||||||||||||
| Datta (2004) | India | 32 | 16/16 | 27/3 | 30 | 100 | 0.5 | SA | No | 72 ± 18 | 66 ± 6 | Before RT | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| De Andres (1998) | Spain | 50 | 25/25 | 31/19 | 36.9 | 50 | 0.25 | GA | No | 50.2 ± 8.2 | 48.6 ± 12.4 | 10 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Eroglu (2010) | Turkey | 39 | 19/20 | 24/15 | 38.0 | 50 | 0.5 | SA | No | 59 ± 12 | 52 ± 16 | 10 min before RT | Yes | RCT | 5(2/2/0/1) |
| Geutjens (1994) | U.K. | 44 | 23/21 | NA | NA | 50 | 0.5 | GA | No | NA | 5 min before RT | Yes | Double-blind | 4(1/0/2/1) | |
| RCT | |||||||||||||||
| Haynes (1994) | U.K. | 20 | 10/10 | NA | NA | 100 | 0.25 | GA | Yes | NA | Before RT | Yes | Double-blind | 5(1/1/2/1) | |
| RCT | |||||||||||||||
| Henderson (1990) | USA | 100 | 51/49 | 56/44 | 29.5 | 75 | 0.25 | GA | No | 45 ± 19 | 52 ± 24 | End of surgery | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Izdes (2003) | Turkey | 60 | 30/30 | 35/25 | 39.7 | 62.5 | 0.25 | GA | No | 33 ± 9 | 33 ± 9 | 10 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| 21 ± 3 | 21 ± 4 | RCT | |||||||||||||
| Marchal (2003) | Spain | 33 | 17/16 | 30/3 | 33.0 | 62.5 | 0.25 | GA | Yes | 72.2 ± 52.9 | 67.5 ± 53.3 | 10 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| 59.6 ± 26.8 | 61 ± 28.1 | RCT | |||||||||||||
| Marret (2005) | France | 30 | 15/15 | 17/13 | 48.5 | 150 | 0.5 | GA | No | 32 ± 6 | 34 ± 6 | 5 min before RT | Yes | Double-blind | 7(2/2/2/1) |
| RCT | |||||||||||||||
| Milligan (1988) | U.K. | 39 | 24/15 | NA | NA | 50 | 0.25 | GA | No | NA | End of surgery | NA | Double-blind | 5(1/1/2/1) | |
| 100 | 0.5 | RCT | |||||||||||||
| Osborne (1993) | Australia | 78 | 38/40 | 55/23 | 33.4 | 100 | 0.5 | GA | No | 39.7 | 39.2 | End of surgery | NA | Double-blind | 6(1/2/2/1) |
| 80 | 40/40 | 60/20 | 34.3 | 100 | 0.5 | GA | Yes | 42.3 | 39.2 | RCT | |||||
| Raja (1992) | USA | 31 | 15/16 | NA | 45 | 50 | 0.25 | SA | Yes | 90 ± 6 | 90 ± 6 | Before RT | Yes | Double-blind | 6(1/2/2/1) |
| RCT | |||||||||||||||
| Smith (1991) | USA | 97 | 49/48 | 65/32 | 35.5 | 150 | 0.5 | GA | No | 53 ± 19 | 56 ± 16 | End of surgery | Yes | Double-blind | 7(2/2/2/1) |
| RCT | |||||||||||||||
| Toivonen (2002) | Finland | 120 | 60/60 | 69/51 | 43.1 | 100 | 0.5 | GA | Yes | 26 ± 14 | 28 ± 10 | End of surgery | NA | Double-blind | 7(2/2/2/1) |
| RCT | |||||||||||||||
| Varrassi (1999) | Italy | 24 | 12/12 | 15/9 | 39 | 50 | 0.25 | GA | No | 29 ± 8 | 34 ± 20 | 10 min before RT | Yes | Double-blind | 6(1/2/2/1) |
| RCT | |||||||||||||||
| Elsharnouby (2008) | Egypt | 54 | 27/27 | 48/6 | NA | 50 | 0.25 | GA | No | 40 ± 5 | 38 ± 5 | 10 min before RT | Yes | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Karamanlioglu (2005) | Turkey | 41 | 21/20 | 20/21 | 40.0 | 100 | 0.5 | GA | No | 85.2 ± 27.3 | 88.5 ± 26.6 | End of surgery | NA | Double-blind | 5(1/1/2/1) |
| RCT | |||||||||||||||
| Tetzlaff (1999) | USA | 20 | 10/10 | NA | NA | 150 | 0.25 | GA | Yes | NA | Before RT | NA | RCT | 4(1/0/2/1) | |
| Shaw (1997) | U.K. | 58 | 31/27 | 51/7 | 36.3 | 100 | 0.5 | GA | No | 40.0 | 33.0 | 5 min before RT | Yes | Double-blind | 6(1/2/2/1) |
| RCT | |||||||||||||||
| Chan (1995) | Singapore | 20 | 10/10 | 20/0 | NA | 50 | 0.25 | GA | No | NA | 5 min before RT | Yes | Double-blind | 4(1/0/2/1) | |
| RCT | |||||||||||||||
BG: Bupivacaine group; F: Female; GA: General anesthesia; M: male; mOCEBM: Modified presentation of the Oxford Centre for Evidence-Based Medicine levels of evidence; NA: Not available; PG: Placebo group; Pts: Patients; R/C/B/F: randomization/concealment of allocation/double-blinding/follow-up of patients; RCT: Randomized controlled trial; RT: Release of the tourniquet; SA: Spinal anesthesia.