A Randomised Controlled Trial to Evaluate the Effectiveness of Intrathecal Bupivacaine Combined with Different Adjuvants (Fentanyl, Clonidine and Dexmedetomidine) in Caesarean Section

Li, Z.; Meng, Tian; Zhang, C.-Y.; Li, A.-Z.; Huang, Aijie; Shi, Cunxian; Xin, Deqian; Qi, J.; Li, K.-Z.

doi:10.1055/s-0034-1395614

Cited by 36 publications

(75 citation statements)

References 33 publications

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“…Fifteen of the included trials reported on the effectiveness of dexmedetomidine on the prevention of perioperative shivering compared with placebo, 11 studies [22–30, 44, 45] administered via spinal route, and 4[36–39] researches via epidural route. Patients investigated in 5 trials [25, 38, 39, 44, 45] were nearly full term parturients selected for cesarean section.…”

Section: Resultsmentioning

confidence: 99%

“…Patients investigated in 5 trials [25, 38, 39, 44, 45] were nearly full term parturients selected for cesarean section. Five studies [22, 28, 31–33] compared different doses of dexmedetomidine via subarachnoid administration.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies [22, 28, 31–33] compared different doses of dexmedetomidine via subarachnoid administration. Other control adjuvants included clonidine [40, 42, 44], fentanyl [24, 34, 39, 43–45], morphine [25], midazolam [23], buprenorphine [35], and butorphanol [41]. …”

Section: Resultsmentioning

confidence: 99%

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Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Zhang

Wang

et al. 2017

PLoS ONE

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BackgroundDexmedetomidine, a highly selective α2-adrenoceptor agonist, has been investigated for anti-shivering effects in some trials. This current meta-analysis was conducted to evaluate the effectiveness of dexmedetomidine as a neuraxial adjuvant in preventing perioperative shivering.MethodsThis systematic review and meta-analysis was registered in PROSPERO [www.crd.york.ac.uk/PROSPERO] with the unique identification number CRD42017055991. The electronic databases PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) were searched to select high-quality randomized controlled trials (RCTs) that evaluated the anti-shivering efficacy for neuraxial application dexmedetomidine as local anesthetic adjuvant. Effects were summarized using pooled risk ratios (RRs), weighed mean differences (MDs), or standardized mean differences (SMDs) and corresponding 95% confidence intervals (Cls) with random effect model. Heterogeneity assessment, sensitivity analysis, and publication bias were performed. The primary outcome was perioperative shivering.ResultsA total of 1760 patients from 24 studies were included in this meta-analysis. Compared with the placebo, dexmedetomidine reduced the incidence of perioperative shivering (RR: 0.34; 95% Cl: 0.21 to 0.55; P < 0.00001), with a maximum effective dose of 5μg via subarachnoid space injection (RR: 0.55; 95% CI: 0.32 to 0.92; P = 0.02), especially in cesarean section (RR: 0.20; 95% CI: 0.09 to 0.45; P = 0.0001). Dexmedetomidine also could improve the characteristics of the block, with an increase only in the incidence of bradycardia (RR: 2.11; 95% CI: 1.23 to 3.60; P = 0.006). No significant difference could be found compared dexmedetomidine with other adjuvants, except morphine.ConclusionsThis meta-analysis shows that dexmedetomidine as a neuraxial adjuvant had statistically significant efficacy on prevention of perioperative shivering. Moreover, dexmedetomidine could improve the characteristics of the block. However, the potential induction of bradycardia should be taken seriously.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Zhang

Wang

et al. 2017

PLoS ONE

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“…According to our literature review, there has been no study in which the effects of clonidine and dexmedetomidine were compared in the perineural model and no comparison with epinephrine. Recent studies have shown that adding dexmedetomidine and clonidine as adjuvants to bupivacaine provides adequate anesthesia and postoperative analgesia compared to fentanyl in caesarean sections (23) and that the addition of dexmedetomidine to epidural bupivacaine can be advantageous with respect to the increased duration of motor and sensory blockade and arousable sedation (24). Kanazi et al (25) examined the effects of bupivacaine added to a low dose of dexmedetomidine or clonidine in spinal anesthesia and showed that both adjuvants decrease block onset time and increase the motor and sensory block times, which is in accordance with our study.…”

Section: Discussionmentioning

confidence: 99%

“…The reaction was prepared as shown below for cDNA synthesis with a total volume of 20 μL and cDNA synthesis was carried out under the following conditions: d(T) 23 VN (50 µM) (2 μL), RNase free water (5 μL), RNA (2 μL), AMV reaction mix (10 μL), AMV enzyme mix (2 μL).…”

Section: Rna Isolation and Cdna Synthesismentioning

confidence: 99%

The effects of bupivacaine combined with different adjuvants on block onset and duration and on ion channel expressions (SCN9A, TRPM) in sciatic nerve block in rats

Dolu¹,

Şahin

Kaplan

et al. 2016

Turk J Med Sci

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Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

Paramasivan

López-Olivo

Foong

et al. 2020

European Journal of Pain

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Background and Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) was undertaken to evaluate the effect of intrathecal dexmedetomidine (DEX) on the duration of postoperative analgesia, postoperative pain scores and incidences of adverse effects. Databases and Data Treatment: Database search was performed from inception until January 2019. All RCTs analysing acute postoperative pain characteristics after intrathecal DEX administration in adults undergoing spinal anaesthesia for elective surgery were included. The primary outcome was postoperative analgesic duration, defined as the time to first analgesic request. The secondary outcomes included pain scores at 6, 12 and 24 postoperative hours and rates of hypotension, bradycardia, shivering and postoperative nausea and vomiting. Results: Twenty-four studies comprising a total of 1,460 patients were included. Postoperative analgesic duration was prolonged with intrathecal DEX compared to placebo, with a pooled mean difference (MD) of 191.3 min (95% CI 168.8-213.8). Patients who received intrathecal DEX reported lower Visual Analogue Scale scores at 24 postoperative hours compared with those patients receiving placebo, with a MD (95% CI) of −1.05 (−1.89 to −0.20, p = 0.02). There were no differences in the incidence of adverse effects, except for a lower rate of postoperative shivering in the intrathecal DEX group (pooled relative risk 0.58, 95% CI 0.34-0.98, p = 0.04). Conclusions: Compared to placebo, intrathecal DEX prolonged postoperative analgesic duration, reduced 24-hr pain intensity and reduced the incidence of shivering without an increase in other adverse effects. Significance: The analgesic role of intrathecal DEX is promising due to its ability to significantly increase postoperative analgesic duration when compared with placebo. Its usage can be considered for patients undergoing surgeries with significant postoperative pain, particularly those intolerant of systemic analgesia. However, the optimal dose for various surgeries as well as its long-term neurological effects warrants further studies.

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A Randomised Controlled Trial to Evaluate the Effectiveness of Intrathecal Bupivacaine Combined with Different Adjuvants (Fentanyl, Clonidine and Dexmedetomidine) in Caesarean Section

Abstract: Addition of dexmedetomidine and clonidine as adjuvants to hyperbaric bupivacaine provided adequate anesthesia and postoperative analgesia compared to fentanyl adjuvant without causing any significant side effects.

Cited by 36 publications

References 33 publications

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

Dexmedetomidine as a neuraxial adjuvant for prevention of perioperative shivering: Meta-analysis of randomized controlled trials

The effects of bupivacaine combined with different adjuvants on block onset and duration and on ion channel expressions (SCN9A, TRPM) in sciatic nerve block in rats

Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials

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