Application of Dexmedetomidine in Epidural Labor Analgesia

Abstract

Objectives: To summarize and appraise the use of dexmedetomidine in epidural labor analgesia, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We conducted the literature search about the RCTs of epidural labor analgesia with or without dexmedetomidine from inception until Nov 1,2022 in the following databases: PubMed, the Cochrane Library and Embase. The primary outcome was visual analogue scale(VAS) within 2h after epidural intubation. The secondary outcomes included the duration of the first and second labor stage, Apgar score, umbilical blood pH, dosage of analgesics, and side effects. Results: 8 RCTs including 846 parturients were included. The VAS score of dexmedetomidine group was significantly lower than that of the control group at the time of 15min(MD -1.41,95%CI -2.23,-0.59)、30min(MD -1.02,95%CI -1.70,-0.33)、60min(MD -0.90,95%CI -1.36,-0.44)、90min(MD -0.70,95%CI -1.16,-0.23). The incidence of pruritus in dexmedetomidine group was lower than that of control group（MD 0.28,95%CI 0.11,0.74）but the incidence of maternal bradycardia was higher (MD 6.41,95%CI 1.64,25.04). There were no significant difference in other outcomes. Discussion: Dexmedetomidine combined with local anesthetic for epidural labor analgesia can improve the VAS score of parturients. Except for the increased incidence of maternal bradycardia, it seems to be safe for the parturients and fetuses.