Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis

Abstract

Objective Previous studies reported the effect of dexmedetomidine on intrathecal anesthesia. In this review, we explored the impact of dexmedetomidine as an adjunct for lumbar anesthesia in patients undergoing cesarean section. Methods Two authors searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Chinese BioMedical database, Chinese Scientific Journal Database, and the Wanfang database. Results Ten trials comprising 970 patients were included in this review. Intrathecal dexmedetomidine significantly reduced the onset time of sensory block (standardized mean difference (SMD), −1.50, 95% confidence interval (CI) −2.15, −0.85, I2 = 92%) and motor block (SMD −0.77, 95% CI −1.50, −0.49, I2 = 60%) and prolonged the block duration time (sensory block: SMD 2.02, 95% CI 1.29, 2.74, I2 = 93%; motor block: SMD 1.90, 95% CI 1.07, 2.74, I2 = 94%). Patients who received dexmedetomidine showed a lower incidence of shivering. No significant difference was reported for the neonatal Apgar score and other complications. Conclusion The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events.

Successful Treatment of Refractory Cancer Pain and Depression with Continuous Intrathecal Administration of Dexmedetomidine and Morphine: A Case Report

“…DEX has been reported to be safe to use intrathecally. Previously published meta-analysis and reviews have shown that intrathecal infusions of DEX can shorten the onset time of spinal anesthesic as well as enhance and prolong their sensory and motor effects, and increasing the time to the need for pain rescue after spinal anesthesia [ 11 , 12 ]. Khosravi et al demonstrated that intrathecal DEX produced better outcomes in terms of analgesia, sedation, and hemodynamic parameters compared to intravenous DEX [ 13 ].…”

Dexmedetomidine Combined with Low‐Dose Norepinephrine Continuous Pumping to Prevent Hypotension after Cesaresan Section: A Randomized Controlled Trial

“…The use of intrathecal dexmedetomidine during cesarean section can shorten the onset time of spinal anesthesia and enhance the effect of local anesthetic. It has no significant impact on neonates and there were no other adverse events [ 7 ]. Although postural regulation and fluid expansion can alleviate hypotension after spinal anesthesia, the incidence of maternal hypotension is still high.…”

“…The primary outcome was defined as the additional dose of NE and the secondary outcome was defined as other indicators of puerperaes and neonates, including the incidence of maternal hypotension. General condition of parturient: age, gestational age, body mass index, volume of bleeding and fluid replacement; intervention dose of norepinephrine and atropine; incidence of maternal hypotension and adverse reactions (reactive hypertension, chest tightness, nausea, shivering, oxytocin reaction); neonatal 1-minute and 5-minute Apgar score [ 7 ] and umbilical cord drive, venous blood gas value. Apgar score: 0–3 is severe asphyxia, 4–7 is mild asphyxia, and 8–10 is no asphyxia.…”

The Options for Neuraxial Drug Administration

“…Like clonidine, when administered as a neuraxial adjuvant it reduces the required local anesthetic dose and prolongs and potentiates post-operative analgesia [ 161 ]. The sensory and motor block doubles when intrathecal dexmedetomidine is used [ 162 ]. Intravenously administered dexmedetomidine also prolongs the anesthetic effect of intrathecal local anesthetics [ 155 , 156 , 163 ].…”