Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Paediatric Caudal Epidural Block: A Randomised Controlled Study

B, Sarvesh; Raj, Prashanth G; Soumya,; Kumar, Vijay; Sharma, Kanchan; Agarwal, Amit

doi:10.7860/jcdr/2019/41703.12916

Cited by 4 publications

(11 citation statements)

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“…Sixty-eight articles were excluded because they were noncomparative studies, did not compare the RD and R groups, were meeting articles, or included different patient types in the 2 groups. Eleven studies, with 337 patients in the R group and 336 patients in the RD group, were ultimately included [ 11 – 13 , 19 – 26 ] (Fig. 1 ).…”

Section: Resultsmentioning

confidence: 99%

Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia

Zhao

Liao

et al. 2021

Medicine

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Background: Ropivacaine is considered the most commonly used for epidural anesthesia. We compared the efficiency and safety of ropivacaine alone (R group) and ropivacaine combined with dexmedetomidine (RD group). Method: PubMed, the Cochrane Library, Google Scholar, Ovid Medline, the Web of Science, Scopus, Embase, and ScienceDirect were searched. We considered sensory and motor block, duration of anesthesia, time to rescue, hemodynamics, and adverse effects as the primary endpoints. Results: Eleven randomized controlled trials were included with 337 patients in the R group and 336 patients in the RD group. The RD group had a shorter time to onset of sensory (mean difference [MD]: 3.97 [1.90–6.04] minutes; P = .0002) and motor (MD: 2.43 [0.70–4.16] minutes; P = .006) block and a longer duration of anesthesia (MD: -164.17 [-294.43 to -33.91]; P = .01) than the R group. Comparison of the time to rescue between the groups showed no significant difference (MD: -119.01[-254.47–16.46] minutes; P = 0.09). The R group showed more stable hemodynamics than the RD group in heart rate and arterial pressure at 10 minutes. The R group had a lower incidence of bradycardia and a higher incidence of shivering than the RD group. Conclusion: RD may be a more suitable choice for epidural anesthesia with better anesthetic outcomes than R alone. However, the safety of the combination must be carefully assessed.

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Section: Resultsmentioning

confidence: 99%

Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia

Zhao

Liao

et al. 2021

Medicine

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“…Thirteen RCTs with a total of 722 pediatric patients (363 who received DEX and 359 who did not receive any adjuvant) were ultimately included in this study, as shown in Figure 1 and Table 1. In 12 studies DEX was compared with saline, [29][30][31][32][33][34][35][36][37][38][39][40] and in one study DEX was compared with clonidine and saline. 41 The main aim of our meta-analysis was to assess the effect of DEX as an adjuvant in pediatric local anesthesia, and thus only DEX versus saline (placebo) was compared and the data on clonidine were ignored.…”

Section: Characteristics Of Eligible Studies and Risk Of Biasmentioning

confidence: 99%

“…41 The main aim of our meta-analysis was to assess the effect of DEX as an adjuvant in pediatric local anesthesia, and thus only DEX versus saline (placebo) was compared and the data on clonidine were ignored. Moreover, nine studies focused on caudal block, [29][30][31][32][33][34][35]40,41 and the remaining four studies were devoted to transversus abdominis block, 36 retrobulbar block, 37 ilioinguinal/iliohypogastric nerve block, 38 and brachial plexus nerve block, 39 respectively. Ropivacaine was administered for patients who received local anesthesia in all studies.…”

Section: Characteristics Of Eligible Studies and Risk Of Biasmentioning

confidence: 99%

“…A total of nine studies were included. [30][31][32][33][34]36,[39][40][41] Using a random effect model, the results showed that the duration of analgesia of the DEX group was significantly longer than the placebo group, and the difference was statistically significant, but there was a significant heterogeneity (standardized mean difference, 7.16; 95%CI, 4.88 to 9.43; P < .001; I 2 = 98%) (Figure 3a).…”

Section: Primary Outcomesmentioning

confidence: 99%

“…Subgroup analysis: To reduce the heterogeneity, a subgroup analysis based on the doses of DEX was conducted. In the DEX groups of the nine studies, five studies were 1 μg/kg DEX, 30,32,36,40,41 three studies were 2 μg/kg DEX, 31,33,34 and one study was 0.75 μg/kg DEX. 39 The results of studies with 1 μg/kg DEX (standardized mean difference, 11.26; 95%CI, 6.98 to 15.54; P < .001; I 2 = 98%) were almost consistent with studies with 2 μg/kg DEX (standardized mean difference, 3.87; 95%CI, 0.38 to 7.35; P = .03; I 2 = 98%) (Figure 3b), which showed that the dose of DEX had no significant influence on the heterogeneity of outcomes, but as a local anesthesia adjuvant, DEX had an obvious effect on improving analgesia duration compared with placebo.…”

Section: Primary Outcomesmentioning

confidence: 99%

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Evaluation of the Efficacy of Dexmedetomidine as a Local Anesthetic Adjuvant in Children: A Meta‐Analysis of Randomized Controlled Trials

Sun

et al. 2022

The Journal of Clinical Pharma

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Dexmedetomidine has been identified as a useful adjunct to improve the effect of nerve blocks in adults; however, its effect for children has not yet been fully investigated. This meta‐analysis aimed to evaluate the reliability and efficacy of dexmedetomidine as a local anesthetic adjunct for pediatric surgeries. Eligible studies were searched in Cochrane, Embase, PubMed, and CBM. RevMan 5.4 was used to assess the risk of bias of each study and perform statistical analysis. Stata 15.0 was used to evaluate the publication bias of primary outcomes. Thirteen randomized controlled trial (RCTs) involving 722 patients aged 6 months to 12 years were harvested. Statistical analysis showed that dexmedetomidine resulted in: a significantly longer duration of analgesia (standardized mean difference [SMD], 7.16; 95% confidence interval [95%CI], 4.88 to 9.43; P < .001; I2 = 98%); a reduction in the 1‐hour pain score (mean difference [MD], –0.27; 95%CI, –0.47 to –0.06; P = .01; I2 = 28%); cumulative doses of rescue analgesic required of 2 doses (risk ratio [RR], 0.26; 95%CI, 0.14 to 0.49; P < .001; I2 = 0) or 3 doses (RR, 0.04; 95%CI, 0.01 to 0.16; P < .001; I2 = 4%); the frequency of emergence agitation (RR, 0.44; 95%CI, 0.22 to 0.91; P = .03; I2 = 0); and a reduction in the onset time of blocks (mean difference –3.56; 95%CI, –6.39 to –0.74; P = .01; I2 = 90%). However, the incidence of some side effects, including hypotension, bradycardia, nausea and vomiting, pruritis, urinary retention, and respiratory depression, did not significantly differ between the dexmedetomidine group and the placebo group. Therefore, dexmedetomidine is a reliable and efficient adjunct to local anesthetics in children.

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Analgesic effect of ropivacaine combined with dexmedetomidine in the postoperative period in children undergoing ultrasound-guided single-shot sacral epidural block: A systematic review and meta-analysis

Quan

Huang

2023

Front. Pediatr.

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ObjectiveThis study aims to evaluate the efficacy of dexmedetomidine as an adjuvant to ropivacaine in prolonging postoperative analgesia and reducing pain scores in children undergoing surgery.MethodsFive online databases were searched for RCTs on postoperative analgesia of pediatric patients undergoing ultrasound-guided single-shot sacral epidural block with dexmedetomidine as an adjuvant to ropivacaine up to January 2, 2023. Pain score and sedation score at 2, 4, 8, 12, and 24 h after the operation, the time of first receiving additional analgesic drugs, and the number of postoperative adverse effects were selected to compare the efficacy and safety of combined treatment with ropivacaine alone for pediatrics. The standard mean difference (SMD) or odds ratio (OR) and the corresponding 95% confidence interval (95%CI) were calculated by using a random-effects model.ResultsA total of 295 articles were retrieved, but only 20 records were included in this meta-analysis. The results showed that dexmedetomidine combined with ropivacaine for sacral epidural block in children undergoing ultrasound-guided single-shot sacral epidural block had a more prolonged analgesia effect (SMD = 3.47, 95%CI: 2.80, 4.14). There were lower analgesia scores at 2 h(T1), 4 h(T2), 8 h(T3), 12 h(T4), and 24 h(T5) in postoperative period (T1: SMD = −1.02, 95%CI: −1.31, −0.72; T2: SMD = −1.02, 95%CI: −1.32, −0.72; T3: SMD = −0.84, 95%CI: −1.12, −0.56; T4: SMD = −0.61, 95%CI: −1.03, −0.20; T5: SMD = −1.03, 95%CI: −1.28, −0.78). And the incidence of adverse effects was similar between the two groups (OR = 0.84, 95%CI: 0.59, 1.18).ConclusionsThe results of this review and meta-analysis support that dexmedetomidine, as an adjuvant to ropivacaine, can improve postoperative analgesia of surgery and significantly prolong the analgesic time in children, with a similar incidence rate of adverse symptoms when compared with ropivacaine alone.

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Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Paediatric Caudal Epidural Block: A Randomised Controlled Study

Cited by 4 publications

References 0 publications

Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia

Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia

Evaluation of the Efficacy of Dexmedetomidine as a Local Anesthetic Adjuvant in Children: A Meta‐Analysis of Randomized Controlled Trials

Analgesic effect of ropivacaine combined with dexmedetomidine in the postoperative period in children undergoing ultrasound-guided single-shot sacral epidural block: A systematic review and meta-analysis

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