Efficacy and Safety of Dexmedetomidine as an Adjuvant in Epidural Analgesia and Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Zhang, Xu; Wang, Dong; Shi, Min; Yuan-guo, Luo

doi:10.1007/s40261-016-0477-9

Cited by 56 publications

(53 citation statements)

References 55 publications

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“…neurons, hyperpolarizing the neuron membrane potentials via G-protein-mediated activation of K + , decreasing sympathetic outflow and norepinephrine release, thus inhibiting the transmission of nociceptive information (7,30). Therefore, the combination of these drugs theoretically produces a synergistic analgesic effect.…”

Section: Discussionmentioning

confidence: 99%

“…The two agents mediate their analgesic effect by stimulating the α2 receptor located post-synaptically on the dorsal horn of the spinal cord (6). A recent systematic meta-analysis demonstrated that dexmedetomidine as an adjuvant in epidural anesthesia provided improved sedation and analgesia with a well-documented safety profile (7). Several studies involving epidural dexmedetomidine in obstetric populations have been published: Dexmedetomidine added to combined spinal (bupivacaine)-epidural (fentanyl) anesthesia for cesarean section (1,2); combined epidural dexmedetomidine and ropivacaine for post-cesarean analgesia (8); and epidural dexmedetomidine combined with ropivacaine or bupivacaine for labor analgesia (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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show abstract

“…[ 24 ] Dexmedetomidine has also successfully been used in central neuraxial block along with local anesthetic agents. [ 25 26 ] Again while performing peripheral nerve block or nerve plexus block, dexmedetomidine has shown its perfect adjuvant role in all the cases. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of analgesic sparing efficacy between dexmedetomidine and clonidine used as adjuvant to ropivacaine in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, double-blind study

et al. 2018

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“…The pro-analgesia effect is achieved via peripheral action [ 31 ], but the promotion of sedation may be due to a systemic mechanism. The sedation resulting from paravertebral DEX may be caused by increased plasma concentrations through local absorption [ 32 ]. The advantage of paravertebral DEX administration is that sedation could develop both through peripheral and systemic mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Paravertebral dexmedetomidine as an adjuvant to ropivacaine protects against independent lung injury during one-lung ventilation: a preliminary randomized clinical trial

Zhang

et al. 2018

BMC Anesthesiol

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BackgroundTo investigate the effect of paravertebral dexmedetomidine as an adjuvant to ropivacaine on independent lung injury during one-lung ventilation.MethodsIn total, 120 patients who underwent elective radical resection of pulmonary carcinoma were randomly assigned to one of six groups (n = 20): normal saline (C group), ropivacaine (R group), intravenous dexmedetomidine (Div group), 0.5 μg/kg paravertebral dexmedetomidine as an adjuvant to ropivacaine (RD0.5 group), 1.0 μg/kg paravertebral dexmedetomidine as an adjuvant to ropivacaine (RD1.0 group), or 2.0 μg/kg paravertebral dexmedetomidine as an adjuvant to ropivacaine (RD2.0 group).Patients in the R, Div, RD0.5, RD1.0 and RD2.0 groups underwent a thoracic paravertebral block, and normal saline was administered as a control to C group. Small marginal lung samples next to the tumor were harvested immediately after the tumor tissues were excised.Lung injury was evaluated as follows: an injury score was determined via light microscopy, and cell apoptosis was determined via a TUNEL assay. TNF-α, IL-6, miRNA-210, HIF-1α, Tom20 and ISCU2 were also detected.ResultsBoth intravenous and paravertebral dexmedetomidine attenuated independent lung injury. Downregulation of HIF-1α and miRNA-210 and upregulation of Tom20 and ISCU2 may be the underlying mechanism. No difference was observed between the Div and RD0.5 groups, and no further improvement of lung injury was found in the RD1.0 and RD2.0 groups with increased paravertebral dexmedetomidine doses.ConclusionsParavertebral dexmedetomidine as an adjuvant to ropivacaine, which is comparable to intravenous dexmedetomidine, could protect against independent lung injury during one-lung ventilation.Trial registrationISRCTN, 13000406; retrospectively registered on 22.05.2018.

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Efficacy and Safety of Dexmedetomidine as an Adjuvant in Epidural Analgesia and Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract: This systematic review and meta-analysis demonstrates that dexmedetomidine as an adjuvant in epidural procedures is generally safe and well tolerated. Furthermore, dexmedetomidine acted synergistically and provided an improved sedation and analgesic profile.

Cited by 56 publications

References 55 publications

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Comparative evaluation of analgesic sparing efficacy between dexmedetomidine and clonidine used as adjuvant to ropivacaine in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, double-blind study

Paravertebral dexmedetomidine as an adjuvant to ropivacaine protects against independent lung injury during one-lung ventilation: a preliminary randomized clinical trial

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