Study Objective:The role of transversus thoracic muscle plane blocks (TTMPBs) during cardiac surgery is controversial. We conducted a systematic review to establish the effectiveness of this procedure. Design:Systematic review. We searched PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure to June 2022, and followed the GRADE approach to evaluate the certainty of evidence. Study Eligibility Criteria:Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block. Main Results:Nine trials that enrolled 454 participants were included. Compared to no block/sham block, moderate certainty evidence found that TTMPB probably reduces postoperative pain at rest at 12 h [weighted mean difference (WMD) -1.51 cm on a 10 cm visual analogue scale for pain, 95% CI -2.02 to -1.00; risk difference (RD) for achieving mild pain or less (& LE;3 cm), 41%, 95% CI 17-65) and 24 h (WMD -1.07 cm, 95% CI -1.83 to -0.32; RD 26%, 95% CI 9-37). Moderate certainty evidence also supported that TTMPB probably reduces pain during movement at 12 h (WMD -3.42 cm, 95% CI -4.47 to -2.37; RD 46%, 95% CI 12-80) and at 24 h (WMD -1.73 cm, 95% CI -3.24 to -0.21; RD 32%, 95% CI 5-59), intraoperative opioid use [WMD -28 milligram morphine equivalent (MME), 95% CI -42 to -15], postoperative opioid consumption (WMD -17 MME, 95% CI -29 to -5), postoperative nausea and vomiting (absolute risk difference 255 less per 1000 persons, 95% CI 140-314), and intensive care unit (ICU) length of stay (WMD -13 h, 95% CI -21 to -6). Conclusion:Moderate certainty evidence showed TTMPB during cardiac surgery probably reduces postoperative pain at rest and with movement, opioid consumption, ICU length of stay, and the incidence of nausea and vomiting.

BACKGROUND: Currently, more and more older people are inevitably facing the final stages of life and their need for end-of-life care is becoming more prominent. It is therefore important to understand in advance what older people expect from their approaching end-of-life care and attention. We conducted a meta-analysis to explore the influence of advance care planning (ACP) on end-of-life decision-making among older adults living in community settings and their family members. METHODS: We searched databases including PubMed, Embase, Cochrane Library, and Web of Science through 10 August 2022, to locate randomized controlled trials (RCTs) that investigated the effects of ACP on the end-of-life decision-making of community-dwelling elderly individuals and their family members. Studies we obtained from the databases were screened based on specific inclusion and exclusion criteria. The software Stata 15.0 was used for combining and analyzing data. RESULTS: A total of 8 RCTs were eligible for meta-analysis. They involved 1,292 community-dwelling elderly people. The meta-analysis results revealed the incidence of the following items among participants after the intervention of the ACP: cardiopulmonary resuscitation (CPR) [rate =26%, 95% confidence interval (CI): 11-41%], life-sustaining treatment (rate =12%, 95% CI: 6-18%), gastric gavage (rate =34%, 95% CI: 18-50%), mechanical ventilation (rate =34%, 95% CI: 14-54%), death at home (rate =7%, 95% CI: 3-12%), and death in hospital (rate =6%, 95% CI: 3-10%). The systematic review protocol was prespecified and registered in the international prospective register of systematic reviews. CONCLUSIONS: According to current research, ACP is a promising treatment that can improve the end of life of elderly people living in the community and their families. However, considering the heterogeneity of the included studies, multi-center RCTs with high quality and larger sample sizes need to be conducted to confirm our conclusions.