Abstract
BackgroundNeuraxial application of dexmedetomidine (DEX) as adjuvant analgesic has been invetigated in some randomized controlled trials (RCTs) but not been approved because of the inconsistency of efficacy and safety in these RCTs. We performed this meta-analysis to access the efficacy and safety of neuraxial DEX as local anaesthetic (LA) adjuvant.MethodsWe searched PubMed, PsycINFO, Scopus, EMBASE, and CENTRAL databases from inception to June 2013 for RCTs that investigated the analgesia efficacy and safety for neuraxial application DEX as LA adjuvant. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMDs) or odds ratio (OR) with suitable effect model. The primary outcomes were postoperative pain intensity and analgesic duration, bradycardia and hypotension.ResultsSixteen RCTs involving 1092 participants were included. Neuraxial DEX significantly decreased postoperative pain intensity (SMD, −1.29; 95% confidence interval (CI), −1.70 to −0.89; P<0.00001), prolonged analgesic duration (WMD, 6.93 hours; 95% CI, 5.23 to 8.62; P<0.00001) and increased the risk of bradycardia (OR, 2.68; 95% CI, 1.18 to 6.10; P = 0.02). No evidence showed that neuraxial DEX increased the risk of other adverse events, such as hypotension (OR, 1.54; 95% CI, 0.83 to 2.85; P = 0.17). Additionally, neuraxial DEX was associated with beneficial alterations in postoperative sedation scores and number of analgesic requirements, sensory and motor block characteristics, and intro-operative hemodynamics.ConclusionNeuraxial DEX is a favorable LA adjuvant with better and longer analgesia. The greatest concern is bradycardia. Further large sample trials with strict design and focusing on long-term outcomes are needed.
Highlights
Neuraxial anesthesia and analgesia provide solid analgesic effect by inhibiting nociceptive transmission from peripheral to central neuronal system [1,2]
DEX might be an interesting adjuvant for neuraxial anesthesia and analgesia to decrease intra- and postoperative anesthetic consumption and prolong the postoperative analgesic duration, but the potentially increased risk of bradycardia, hypotension and neurotoxicity should be taken into consideration in clinic settings
The results from these two meta-analyses might be biased, because 1. the pooled results were not based on all the currently available randomized controlled trials (RCTs) on neuraxial DEX; 2. only the primary outcomes of the sensory and motor block durations were pooled for neuraxial DEX; 3. the analgesic and side effects of adjunct neuraxial DEX to local anaesthetic (LA) has not been carefully investigated; 4. no effort was made to explore the significant heterogeneity within the RCTs
Summary
Neuraxial anesthesia and analgesia provide solid analgesic effect by inhibiting nociceptive transmission from peripheral to central neuronal system [1,2] Their analgesic advantages might be limited by the short life of current local anesthetics (LAs), and, especially, be weakened during postoperative pain control [3]. DEX might be an interesting adjuvant for neuraxial anesthesia and analgesia to decrease intra- and postoperative anesthetic consumption and prolong the postoperative analgesic duration, but the potentially increased risk of bradycardia, hypotension and neurotoxicity should be taken into consideration in clinic settings. No effort was made to explore the significant heterogeneity within the RCTs. we performed the current systematic review and meta-analysis focusing on postoperative pain outcomes (pain intensity and analgesic duration) and major adverse events (bradycardia and hypotension) of neuraxial DEX as an adjuvant compared with LA alone. We performed this meta-analysis to access the efficacy and safety of neuraxial DEX as local anaesthetic (LA) adjuvant
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