Effects of Intravenous and Intrathecal Dexmedetomidine in Spinal Anesthesia: A Meta‐Analysis

Niu, Xiaoyin; Ding, Xuan; Guo, Ting; Chen, Ming‐Hui; Fu, Shanlin; Li, Quan

doi:10.1111/cns.12172

Cited by 81 publications

(85 citation statements)

References 32 publications

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“…Nevertheless, our results were inconsistent with a previous meta-analysis suggesting that the use of dexmedetomidine during spinal anesthesia did not show significant hemodynamic differences. 30 This discrepancy with our study may be explained by the fact that the previous meta-analysis contained a combination of major and minor surgeries not associated with significant blood loss. Furthermore, the hypotension seen in the PACU in our study may have been compounded by deflating the tourniquet at the end of the surgery.…”

Section: Discussioncontrasting

confidence: 84%

Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial

Chan

Maslany

Gorman

et al. 2016

Can J Anesth/J Can Anesth

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Background It remains unclear whether the opioidsparing effects of dexmedetomidine seen in patients undergoing general anesthesia are reproducible in patients undergoing spinal anesthesia. We hypothesized that the administration of intravenous dexmedetomidine for sedation during total knee arthroplasty under spinal anesthesia would decrease postoperative morphine consumption in the first 24 hr following surgery. Methods We conducted this prospective double-blind randomized-controlled trial in 40 patients (American Society of Anesthesiologists physical status I-III) undergoing total knee arthroplasty with a standardized spinal anesthetic. Patients were randomized to receive either a dexmedetomidine loading dose of 0.5 lgÁkg -1 over ten minutes, followed by an infusion of 0.5 lgÁkgÁhr -1 for the duration of the surgery, or a normal saline loading dose and an infusion of an equivalent volume. The primary outcome was the consumption of morphine delivered via patientcontrolled analgesia in the first 24 hr following surgery. Results The mean (SD) cumulative morphine at 24 hr in the dexmedetomidine group was 29.2 (11.2) mg compared with 61.2 (17.2) mg in the placebo group (mean difference, 32.0 mg; 95% confidence interval, 22.7 to 41.2; P \ 0.001). In the dexmedetomidine group, there was a delay in the time to first analgesic request (P = 0.003) and a reduction in the mean morphine use at six and 12 hr following surgery (both P \ 0.001).Conclusions Dexmedetomidine was associated with a significant decrease in morphine use in the first 24 hr following total knee arthroplasty. Our study shows that an intraoperative infusion of dexmedetomidine for sedation in patients receiving spinal anesthesia can produce postoperative analgesic effects. This offers another potential adjunct in the multimodal pain management of these patients. This trial was registered at ClinicalTrials.gov (identifier NCT02026141).

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Section: Discussioncontrasting

confidence: 84%

Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial

Chan

Maslany

Gorman

et al. 2016

Can J Anesth/J Can Anesth

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“…Similarly Niu et al in a meta-analysis found that use of dexmedetomidine either intravenously or intrathecally resulted increase incidence of bradycardia requiring atropine [39]. The reported bradycardia in all these studies was transient and were easily reversed with intravenous atropine.…”

Section: Bradycardiamentioning

confidence: 87%

“…Sensory block duration was prolonged by at least 34% (CI limit, Point estimate 38%) and motor blockade by at least 17% (CI limit, point estimate 21%) [27]. Another meta-analysis on the effects of intravenous and intrathecal dexmedetomidine in spinal Anaesthesia found that whatever route of administration, dexmedetomidine could prolonged the sensory and motor blockade, although there was significant heterogeneity in the duration of sensory and motor in intravenous route, such results were not found consistently in intrathecal route [39]. Several studies reported prolonged duration of motor block following use of intravenous dexmedetomidine bolus followed by infusion.…”

Section: Duration Of Blockmentioning

confidence: 99%

“…The mechanism of synergistic action of dexmedetomidine on spinal local anaesthesia is still not clear. However, supra-spinal, spinal or direct analgesia and or vasoconstriction activities are involved [32,[37][38][39][40][41][42][43]. More-over, dexmedetomidine produces a greater degree of differential blockade by preferentially blocking the myelinated A alpha-fibers involved in motor conduction [27].…”

Section: Intravenous Dexmedetomidine On Quality Of Sensory-motor Blocmentioning

confidence: 99%

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Role of Intravenous Dexmedetomidine in Prolonging Postoperative Analgesia and Quality of Block Following Spinal Anaesthesia. A Systemic Review and Update

Upadhyay¹,

Samanth²,

Tellicherry³

et al. 2015

J Pain Relief

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“…Dexmedetomidine, by stimulating alpha 2 receptors at dorsal horn neurons of the spinal cord reduces the sympathetic discharge and also modulates the release of substance P and causes hyper polarization of dorsal horn neurons. 6,[15][16][17][18] Buprenorphine is an opioid and it acts by stimulating kappa and mu opioid receptors and partially inhibiting delta opioid receptors. And it has both spinal and supra spinal component of analgesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

Amitha¹,

Pradeep

2017

Int J Adv Med

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INTRODUCTIONSpinal anesthesia is the choice of regional anesthesia technique for surgeries on the lower limbs, as it preserves consciousness, spontaneous breathing at the same time provides for analgesia and muscle relaxation.1,2 These advantages can be minimized when local anaesthetic alone is used for spinal anaesthesia, as it provides for shorter duration of action.2,3 Many adjuvants like fentanyl, buprenorphine have been tried and are effective to prolong the anaesthetic effects.2,4 Dexmedetomidine, is a selective alpha2-adrenoreceptor agonist has been used for analgesia and intravenous sedation in intensive care unit. 5,6 When used for spinal anasethesia, it acts on the ABSTRACT Background: Buprenorphine is being used as an adjuvant to local anaesthetic for spinal anaesthesia since long. Dexmedetomidine is a new drug which has got alpha 2 agonistic property, and is being tried for spinal anesthesia along with bupivacaine in recent times. Settings and Design: This study was conducted in a prospective, randomized, controlled and double-blind manner. The study included ninety American Society of Anaesthesiologists class I and II patients undergoing tibial interlocking nailing surgeries under spinal anaesthesia. Methods:The patients were randomly divided into three groups (n=30 each) by closed envelope technique. Patients in group 1 received 15 mg of 0.5% hyperbaric bupivacaine, group 2 received 15 mg of 0.5% hyperbaric bupivacaine with 30μg of buprenorphine, and group 3 received 15 mg of 0.5% hyperbaric bupivacaine with 5μg dexmedetomidine for spinal anesthesia. The duration of motor and sensory blockade and any adverse events were recorded. Data were analysed using Chi-square test or Fisher's exact test for categorical data and analysis of variance for continuous data. A value of P<0.05 was considered as statistically significant. Results: In our study the subjects in group 3 (dexmedetomidine) group had significantly longer period of motor blockade (240±20min) and sensory blockade (180±22.2min) compared to other groups, which is statistically significant (P=0.0001 and P= 0.006 respectively). The time to first request of analgesic in the post-operative period was also longer (240±30.2min) in dexmedetomidine group when compared with other groups (P=0.0001). There were no untoward complications (hypotension, sedation) in any groups. Conclusions:We concluded that dexmedetomidine (5μg) with bupivacaine for spinal anesthesia gives significantly longer duration of sensory and motor blockade, than buprenorphine (30μg) with bupivacaine for spinal anaesthesia.

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Effects of Intravenous and Intrathecal Dexmedetomidine in Spinal Anesthesia: A Meta‐Analysis

Abstract: This meta-analysis has shown that dexmedetomidine prolonged the duration of spinal anesthesia and improved postoperative analgesia and did not increase the incidence of hypotension and adverse events, but needs more atropine to reverse bradycardia.

Cited by 81 publications

References 32 publications

Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial

Dexmedetomidine during total knee arthroplasty performed under spinal anesthesia decreases opioid use: a randomized-controlled trial

Role of Intravenous Dexmedetomidine in Prolonging Postoperative Analgesia and Quality of Block Following Spinal Anaesthesia. A Systemic Review and Update

Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries

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