TY - JOUR
T1 - Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in brachial plexus block a systematic review and meta-analysis of 18 randomized controlled trials
AU - Hussain, Nasir
AU - Grzywacz, Vincent Paul
AU - Ferreri, Charles Andrew
AU - Atrey, Amit
AU - Banfield, Laura
AU - Shaparin, Naum
AU - Vydyanathan, Amaresh
N1 - Publisher Copyright:
© 2017 American Society of Regional Anesthesia and Pain Medicine.
PY - 2017
Y1 - 2017
N2 - Background and Objectives: Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. Methods: Ameta-analysis of randomized controlled trialswas conducted to assess the ability of dexmedetomidine to prolong the duration and hasten the onset of motor and sensory blockade when used as an adjuvant to local anesthesia for brachial plexus blockade versus using local anesthesia alone (control). A search strategy was created to identify eligible articles in MEDLINE, EMBASE, and The Cochrane Library. The methodological quality for each included study was evaluated using the Cochrane Tool for Risk of Bias. Results: Eighteen randomized controlled trials were included in this metaanalysis (n = 1092 patients). The addition of dexmedetomidine significantly reduced sensory block time onset time by 3.19 minutes (95% confidence interval [CI], -4.60 to -1.78 minutes; I2 = 95%; P < 0.00001), prolonged sensory block duration by 261.41 minutes (95% CI, 145.20-377.61 minutes; I2 = 100%; P < 0.0001), reduced the onset of motor blockade by 2.92minutes (95% CI, -4.37 to -1.46 minutes; I2 = 96%, P < 0.0001), and prolongedmotor block duration by 200.90 minutes (CI, 99.24-302.56 minutes; I2 = 99%; P = 0.0001) as compared with control. Dexmedetomidine also significantly prolonged the duration of analgesia by 289.31 minutes (95% CI, 185.97-392.64 minutes; I2 = 99%; P < 0.00001). Significantlymore patients experienced intraoperative bradycardia with dexmedetomidine (risk difference [RD], 0.06; 95% CI, 0.00-0.11; I2 = 72%; P = 0.03); however, there was no difference in the incidence of intraoperative hypotension (RD, 0.01; 95% CI, -0.02 to 0.04; I2 = 3%; P = 0.45). It is important to note that all studies reported that intraoperative bradycardia was either transient in nature or reversible, when needed, with the administration of intravenous atropine. Conclusions: Dexmedetomidine has the ability to hasten the onset and prolong the duration of blockade when used as an adjuvant to local anesthesia for brachial plexus blockade. Considering an analgesic effect to be either decreased pain, a longer duration of analgesic block, or decreased opioid consumption, the addition of dexmedetomidine to local anesthetics for brachial plexus blockade was found to significantly improve analgesia in all 18 included studies. However, patients receiving dexmedetomidine should be continuouslymonitored for the potentially harmful but reversible adverse effect of intraoperative bradycardia. Level of Evidence: Therapeutic, level I.
AB - Background and Objectives: Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. Methods: Ameta-analysis of randomized controlled trialswas conducted to assess the ability of dexmedetomidine to prolong the duration and hasten the onset of motor and sensory blockade when used as an adjuvant to local anesthesia for brachial plexus blockade versus using local anesthesia alone (control). A search strategy was created to identify eligible articles in MEDLINE, EMBASE, and The Cochrane Library. The methodological quality for each included study was evaluated using the Cochrane Tool for Risk of Bias. Results: Eighteen randomized controlled trials were included in this metaanalysis (n = 1092 patients). The addition of dexmedetomidine significantly reduced sensory block time onset time by 3.19 minutes (95% confidence interval [CI], -4.60 to -1.78 minutes; I2 = 95%; P < 0.00001), prolonged sensory block duration by 261.41 minutes (95% CI, 145.20-377.61 minutes; I2 = 100%; P < 0.0001), reduced the onset of motor blockade by 2.92minutes (95% CI, -4.37 to -1.46 minutes; I2 = 96%, P < 0.0001), and prolongedmotor block duration by 200.90 minutes (CI, 99.24-302.56 minutes; I2 = 99%; P = 0.0001) as compared with control. Dexmedetomidine also significantly prolonged the duration of analgesia by 289.31 minutes (95% CI, 185.97-392.64 minutes; I2 = 99%; P < 0.00001). Significantlymore patients experienced intraoperative bradycardia with dexmedetomidine (risk difference [RD], 0.06; 95% CI, 0.00-0.11; I2 = 72%; P = 0.03); however, there was no difference in the incidence of intraoperative hypotension (RD, 0.01; 95% CI, -0.02 to 0.04; I2 = 3%; P = 0.45). It is important to note that all studies reported that intraoperative bradycardia was either transient in nature or reversible, when needed, with the administration of intravenous atropine. Conclusions: Dexmedetomidine has the ability to hasten the onset and prolong the duration of blockade when used as an adjuvant to local anesthesia for brachial plexus blockade. Considering an analgesic effect to be either decreased pain, a longer duration of analgesic block, or decreased opioid consumption, the addition of dexmedetomidine to local anesthetics for brachial plexus blockade was found to significantly improve analgesia in all 18 included studies. However, patients receiving dexmedetomidine should be continuouslymonitored for the potentially harmful but reversible adverse effect of intraoperative bradycardia. Level of Evidence: Therapeutic, level I.
UR - http://www.scopus.com/inward/record.url?scp=85013807210&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013807210&partnerID=8YFLogxK
U2 - 10.1097/AAP.0000000000000564
DO - 10.1097/AAP.0000000000000564
M3 - Review article
C2 - 28178091
AN - SCOPUS:85013807210
SN - 1098-7339
VL - 42
SP - 184
EP - 196
JO - Regional anesthesia and pain medicine
JF - Regional anesthesia and pain medicine
IS - 2
ER -