Evaluation of the effect of dexmedetomidine combined with ropivacaine in epidural labor analgesia: a systematic review and meta-analysis

Abstract

This review and meta-analysis comprehensively elaborated the analgesic and sedative effects of ropivacaine combined with dexmedetomidine in epidural labor analgesia, and its possible resulting motor block and adverse reactions. PubMed, Web of science, Cochrane, China National Knowledge Infrastructure and WANFANG DATA were searched for randomized controlled trials (RCTs) on the efficacy and safety of ropivacaine combined with dexmedetomidine in epidural labor analgesia. Standard mean difference (SMD) and 95% confidence interval (CI) were calculated. As of September 10th, 17 articles were finally included for meta-analysis. The results showed that compared with the control group (ropivacaine alone or ropivacaine + sufentanil), singleton full-term pregnant patients treated with ropivacaine + dexmedetomidine had better analgesic and sedative effects, with lower VAS scores at 15 min (T<inf>1</inf>), 30 min (T<inf>2</inf>), 1 h (T<inf>3</inf>), 2 h (T<inf>4</inf>) after labor analgesia, and the moment of delivery (T<inf>5</inf>) (T<inf>1</inf>: SMD=-1.90, 95% CI: -2.39, -1.40; T<inf>2</inf>: SMD=-1.43, 95% CI: -1.92, -0.93; T<inf>3</inf>: SMD=-0.91, 95% CI: -1.41, -0.41; T<inf>4</inf>: SMD=-0.94, 95% CI: -1.54, -0.34; T<inf>5</inf>: SMD=-0.56, 95% CI: -1.02, -0.10) and higher Ramsay scores at 15 min (T<inf>1</inf>) and 30 min (T<inf>2</inf>) after labor analgesia (T<inf>1</inf>: SMD=1.17, 95% CI: 0.80, 1.53; T<inf>2</inf>: SMD=2.17, 95% CI: 1.30, 3.03). In patients with singleton full-term pregnancy, ropivacaine + dexmedetomidine have better analgesic and sedative effects than in the control group. Both groups have no significant motor block and neonatal asphyxia and hypoxia.