Evaluation of the Efficacy of Dexmedetomidine as a Local Anesthetic Adjuvant in Children: A Meta-Analysis of Randomized Controlled Trials.

Abstract

Dexmedetomidine has been identified as a useful adjunct to improve the effect of nerve blocks in adults; however, its effect for children has not yet been fully investigated. This meta-analysis aimed to evaluate the reliability and efficacy of dexmedetomidine as a local anesthetic adjunct for pediatric surgeries. Eligible studies were searched in Cochrane, Embase, PubMed, and CBM. RevMan5.4 was used to assess the risk of bias of each study and perform statistical analysis. Stata15.0 was used to evaluate the publication bias of primary outcomes. Thirteen randomized controlled trial (RCTs) involving 722 patients aged 6months to 12years were harvested. Statistical analysis showed that dexmedetomidine resulted in: a significantly longer duration of analgesia (standardized mean difference [SMD], 7.16; 95% confidence interval [95%CI], 4.88 to 9.43; P<.001; I2 =98%); a reduction in the 1-hour pain score (mean difference [MD], -0.27; 95%CI, -0.47 to -0.06; P=.01; I2 =28%); cumulative doses of rescue analgesic required of 2 doses (risk ratio [RR], 0.26; 95%CI, 0.14 to 0.49; P<.001; I2 =0) or 3 doses (RR, 0.04; 95%CI, 0.01 to 0.16; P<.001; I2 =4%); the frequency of emergence agitation (RR, 0.44; 95%CI, 0.22 to 0.91; P=.03; I2 =0); and a reduction in the onset time of blocks (mean difference -3.56; 95%CI, -6.39 to -0.74; P=.01; I2 =90%). However, the incidence of some side effects, including hypotension, bradycardia, nausea and vomiting, pruritis, urinary retention, and respiratory depression, did not significantly differ between the dexmedetomidine group and the placebo group. Therefore, dexmedetomidine is a reliable and efficient adjunct to local anesthetics in children.