Comparison of Dexmedetomidine and Clonidine as Adjuvants to Local Anesthetics for Intrathecal Anesthesia: A Meta-Analysis of Randomized Controlled Trials

2015 ◽  
Vol 56 (7) ◽  
pp. 827-834 ◽  
Author(s):  
Changsheng Zhang ◽  
Changtian Li ◽  
Massimiliano Pirrone ◽  
Li Sun ◽  
Weidong Mi
Keyword(s):  
Randomized Controlled Trials ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Nijuan Li ◽  
Li Hu ◽  
Chunping Li ◽  
Xuelin Pan ◽  
Yong Tang
Keyword(s):  
Sensitivity Analysis ◽  
Randomized Controlled Trials ◽  
Local Anesthetics ◽  
Analgesic Effect ◽  
Meta Analysis ◽  
Labor Analgesia ◽  
Labor Pain ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference

Background. This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor. Methods. Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data. Results. Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min ( P = 0.002 ), 30 min ( P = 0.01 ), and 120 min ( P = 0.02 ) after block and at the moment of fetal disengagement ( P = 0.0002 ), decreased mean arterial pressure of 120 min ( P = 0.01 ), heart rate of 30 min ( P = 0.003 ), 60 min ( P < 0.00001 ), and 120 min ( P < 0.00001 ) after block, blood loss ( P = 0.02 ), and the incidence of nausea/vomiting ( P = 0.006 ), and increased the incidence of maternal bradycardia ( P = 0.04 ). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block ( P < 0.00001 ) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting ( P = 0.002 ), increased the incidence of maternal bradycardia ( P = 0.04 ), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different. Conclusions. Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.

scholarly journals Lidocaine vs. Other Local Anesthetics in the Development of Transient Neurologic Symptoms (TNS) Following Spinal Anesthesia: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 9 (2) ◽  
pp. 493 ◽  
Author(s):  
Chang-Hoon Koo ◽  
Hyun-Jung Shin ◽  
Sung-Hee Han ◽  
Jung-Hee Ryu
Keyword(s):  
Randomized Controlled Trials ◽  
Spinal Anesthesia ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Control Groups ◽  
Lidocaine Group ◽  
Randomized Controlled ◽  
Meta Analyses

The use of lidocaine in spinal anesthesia may increase the risk of transient neurological symptoms (TNS) according to previous meta-analyses. However, the previous meta-analyses lacked data on some other local anesthetics and thus, more evaluations are still needed to compare the effect of lidocaine on the development of TNS. The objective of this study was to compare the risk of TNS according to lidocaine versus other local anesthetics in patients undergoing spinal anesthesia. A total of 39 randomized controlled trials with 4733 patients were analyzed. The incidence of TNS was 10.8% in the lidocaine group and was 2.2% in the control groups (risk ratio (RR) 4.12, 95% confidence interval (CI) 3.13 to 5.43, p < 0.001). In subgroup analysis, lidocaine increased the incidence of TNS compared with other local anesthetics except mepivacaine, ropivacaine or sameridine. The risk of TNS was higher in the hyperbaric (p < 0.001) or isobaric lidocaine (p < 0.001) group compared with the control group, but there were no differences found between the two groups when hypobaric lidocaine was administered (p = 1.00). This study confirmed that lidocaine for spinal anesthesia still causes TNS more frequently than most other local anesthetics, especially when hyperbaric or isobaric lidocaine was used.

scholarly journals Liposome Bupivacaine Compared to Plain Local Anesthetics to Reduce Postsurgical Pain: An Updated Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Mark C. Kendall ◽  
Lucas Jorge Castro Alves ◽  
Gildasio De Oliveira
Keyword(s):  
Randomized Controlled Trials ◽  
Local Anesthetic ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Postsurgical Pain ◽  
Randomized Controlled ◽  
Pubmed Database ◽  
Significant Difference ◽  
Liposome Bupivacaine

Objective. Peripheral nerve blocks for postoperative analgesia have improved block success, but analgesia efficacy has been limited by the short duration of traditional local anesthetics. The results of randomized trials comparing liposome bupivacaine with conventional local anesthetic formulations (e.g., plain bupivacaine and ropivacaine) have generated conflicting results. This study was conducted to systematically review the effectiveness of analgesic efficacy of liposome bupivacaine infiltration at the surgical site versus plain local anesthetic bupivacaine or ropivacaine in patients undergoing surgery. Methods. PRISMA statement guidelines were followed. A search of electronic databases National Library of Medicine’s PubMed database, Cochrane Database of Systematic Reviews, Embase, and Google Scholar from January 2012 to September 2017 was performed. Among the 1,612 records identified, 9 randomized controlled trials involving 779 patients were eligible for data extraction and meta-analysis. Results. Liposome bupivacaine did not reduce postsurgical pain at rest compared to plain local anesthetics at 24 and 48 hours after surgery. Moreover, liposome bupivacaine did not reduce postoperative opioid consumption at 24, 48, or 72 hours when compared to plain local anesthetics. Liposome bupivacaine did reduce postoperative nausea when compared to plain local anesthetics (P =<0.3). There was no significant difference in hospital length of stay between study groups, the use of plain bupivacaine or ropivacaine, or among orthopedic or nonorthopedic procedures. No manifestations of local anesthetic toxicity were reported. Conclusions. Our results suggest that liposome bupivacaine does not have an analgesic advantage when compared to plain local anesthetics at the surgical site for patients undergoing surgical procedures.

scholarly journals Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

2020 ◽  
Author(s):  
Liping Pan ◽  
Hao Wu ◽  
Heng Liu ◽  
Xin Yang ◽  
Zhichao Meng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Randomized Controlled Trials ◽  
Nerve Block ◽  
Local Anesthetics ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Motor Strength

Abstract Background: Dexmedetomidine showed some potential in pain control in patients undergoing Total Knee Arthroplasty (TKA). Nerve block is a preferable alternative for postoperative analgesia after TKA, on which dexmedetomidine had an effect controversially. This study aimed to meta-analyze the available randomized controlled trials to determine the efficacy and safety of dexmedetomidine as an adjunct to local anesthetics in nerve block after TKA. Methods: PubMed, Embase, Cochrane Library, Web of science and ScienceDirect databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to February 1 st , 2020 . The primary outcomes included pain scores, duration of analgesia, total opioids consumption in 24 hours postoperatively, and patient satisfaction. The second outcomes were motor strength, sedation degree and postoperative nausea and vomiting, and other related complications. The methodological quality was assessed by the Cochrane risk of bias tool. Results: The initial search yielded 143 studies, of which 7 met the inclusion criteria finally. The pooled data indicated that dexmedetomidine combined with local anesthetics in nerve block in TKA could decrease postoperative pain scores at rest (SMD=-1.01[95%CI, -1.29 to -0.72], p<0.01) and at motion(SMD=-1.01[-1.25 to -0.77], p<0.01,), decrease the total opioids consumption within 24 hours(SMD=-0.63[-0.86 to -0.40], p<0.01), prolong the analgesia duration(SMD=0.90[0.64 to 1.17], p<0.01), improve motor strength(SMD=0.23[0.01 to 0.45], p=0.04) and the sedation degree (SMD=0.94[0.70 to 1.18], p<0.01), and increase the patient satisfaction(SMD=0.88[0.60 to 1.17], p<0.01) without adding nausea and vomiting(RD=-0.05[-0.11 to 0.01],p=0.14), and other related complications(RD=-0.01[-0.08 to 0.07],p=0.89), compared with local anesthetics alone in nerve block. Conclusions: It was effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioids consumption, prolong analgesic duration and increase patient satisfaction without increasing related complications. Based on the quality evidence we got, we recommended dexmedetomidine as a regular regimen in nerve block for patients undergoing TKA. Registration: This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews) and the registering number was CRD42020169171.

Sign in / Sign up

Export Citation Format

Share Document