Abstract
Background and ObjectivesPeripheral injection of dexmedetomidine (DEX) has been widely used in regional anesthesia to prolong the duration of analgesia. However, the optimal perineural dose of DEX is still uncertain. It is important to elucidate this characteristic because DEX may cause dose-dependent complications. The aim of this meta-analysis was to determine the optimal dose of perineural DEX for prolonged analgesia after brachial plexus block (BPB) in adult patients undergoing upper limb surgery.MethodA search strategy was created to identify suitable randomized clinical trials (RCTs) in Embase, PubMed and The Cochrane Library from inception date to Jan, 2021. All adult patients undergoing upper limb surgery under BPB were eligible. The RCTs comparing DEX as an adjuvant to local anesthetic (LA) with LA alone for BPB were included. The primary outcome was duration of analgesia for perineural DEX. Secondary outcomes included visual analog scale (VAS) in 12 and 24 h, consumption of analgesics in 24 h, and adverse events.ResultsFifty-seven RCTs, including 3332 patients, were identified. The subgroup analyses and regression analyses revealed that perineural DEX dose of 30-50 μg is an appropriate dosage. With short−/intermediate-acting LAs, the mean difference (95% confidence interval [CI]) of analgesia duration with less than and more than 60 μg doses was 220.31 (153.13–287.48) minutes and 68.01 (36.37–99.66) minutes, respectively. With long-acting LAs, the mean differences (95% CI) with less than and more than 60 μg doses were 332.45 (288.43–376.48) minutes and 284.85 (220.31–349.39) minutes.Conclusion30-50 μg DEX as adjuvant can provides a longer analgesic time compared to LA alone and it did not increase the risk of bradycardia and hypotension.
Highlights
Upper limb surgery is often performed under brachial plexus block (BPB), which is a series of regional anesthesia techniques and contributes to reliable postoperative analgesia [1]
113 articles were excluded after screened titles and abstracts. 26 articles were excluded after full-text reading for the following reasons: retracted article, not single injection, lack of required outcomes, randomized clinical trials (RCTs) registration, not English
DEX was used as an adjuvant to several different local anesthetics, which included ropivacaine [23, 34, 39, 41, 42, 45,46,47, 49, 50, 52, 56, 57, 59, 63,64,65,66, 68, 72,73,74, 76, 78, 80, 81, 84, 85], bupivacaine [20, 35, 37, 38, 40, 51, 53,54,55, 67, 69, 71], levobupivacaine [21, 43, 44, 48, 60,61,62, 79, 83], and lidocaine [22, 36, 70, 77, 86]
Summary
Upper limb surgery is often performed under brachial plexus block (BPB), which is a series of regional anesthesia techniques and contributes to reliable postoperative analgesia [1]. Adjuvants of local anesthetics such as opioids [4], epinephrine [5], clonidine [6], magnesium [7], midazolam [8], dexamethasone [9], buprenorphine [10] and dexmedetomidine (DEX) [11] have been proved to prolong the analgesic time of nerve block, and have achieved varying degrees of success Among these different kinds of adjuvants, DEX is more widely used. It is important to elucidate this characteristic because DEX may cause dose-dependent complications The aim of this meta-analysis was to determine the optimal dose of perineural DEX for prolonged analgesia after brachial plexus block (BPB) in adult patients undergoing upper limb surgery
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