Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial

Fan, Ming; Li, Juan; Cao, Rong; Hu, Lili; Lu, Sunshan

doi:10.21037/apm-22-264

Cited by 10 publications

(17 citation statements)

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“…Finally, 8 RCTs comprising 846 parturients met inclusion criteria after full article review and exclusion. [13][14][15][16][17][18][19][20] The characteristics and details of the articles are shown in Table 1, with 7 articles from China and 1 from India. All articles were published in 2017 to 2022.…”

Section: Results Of Literature Searchmentioning

confidence: 99%

“…Another study found that the optimal concentration was 0.5 ðg/mL for epidural labor analgesia when dexmedetomidine was combined with 0.1% ropivacaine. The concentration of dexmedetomidine included in this meta-analysis were 0.5 ðg/mL in 7 studies [14][15][16][17][18][19][20] and 0.4 ðg/mL in 1 study. 13 Thus, we believed that the difference in the dosage of dexmedetomidine had a minor impact on the results of our meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…All the included studies analyzed side effects. Four studies reported the incidence of nausea and vomiting, 13,14,17,20 3 studies reported the incidence of urinary retention, 16,18,19 3 studies reported the incidence of shivering, 14,16,17 5 articles counted the incidence of hypotension, [14][15][16][17][18] 3 articles reported the incidence of conversion to cesarean section, 16,17,20 and 3 were no significant difference between the 2 groups. Six studies reported the incidence of pruritus, 13,[15][16][17][18][19] and the results showed that the incidence in the dexmedetomidine group was lower than that of the control group for pruritus (MD 0.28, 95% CI 0.11, 0.74, I 2 = 24%).…”

Section: Side Effectsmentioning

confidence: 99%

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Application of Dexmedetomidine in Epidural Labor Analgesia

Zhang,

Sun,

2023

The Clinical Journal of Pain

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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.

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Section: Results Of Literature Searchmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Side Effectsmentioning

confidence: 99%

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Application of Dexmedetomidine in Epidural Labor Analgesia

Zhang,

Sun,

2023

The Clinical Journal of Pain

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“…This allows us to preserve cooperation between the operator and the patient. Analgesia is a basis for such cooperation and dexmedetomidine exerts an analgesic effect, either given systematically or as an adjuvant to regional anaesthesia, as well as an opioid-sparing effect [ 13 , 14 , 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Relationship between Baseline Autonomic Tone and Haemodynamic Effects of Dexmedetomidine

et al. 2023

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Dexmedetomidine, a central α-2 agonist, is used for procedural sedation and for conscious sedation influences on heart rate and blood pressure. Authors verified whether it is possible to predict bradycardia and hypotension with the use of heart rate variability (HRV) analysis for an autonomic nervous system (ANS) activity assessment. The study included adult patients of both sexes with an ASA score of I or II scheduled for ophthalmic surgery to be performed under sedation. The loading dose of dexmedetomidine was followed by a 15 min infusion of the maintenance dose. The frequency domain heart rate variability parameters from the 5-min Holter electrocardiogram recordings before dexmedetomidine administration were used for the analysis. The statistical analysis also included pre-drug heart rate and blood pressure as well as patient age and sex. The data from 62 patients were analysed. There was no relationship between the decrease in heart rate (42% of cases) and initial HRV parameters, haemodynamic parameters or sex and age of patients. In multivariate analysis, the only risk factor for a decrease in mean arterial pressure (MAP) > 15% from the pre-drug value (39% of cases) was the systolic blood pressure before dexmedetomidine administration as well as for a >15% decrease in MAP sustained at more than one consecutive time point (27% of cases). The initial condition of the ANS did not correlate with the incidence of bradycardia or hypotension; HRV analysis was not helpful in predicting the abovementioned side effects of dexmedetomidine.

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“…Studies have shown that DEX can exert analgesic efects by stimulating nerve cells to release cholate-like substances to expand the pain threshold of the body [18]. Meanwhile, it can enhance the frequency and intensity of myometrial contractions, reduce uterine bleeding, and accelerate labor, making it suitable for labor analgesia [19,20]. Te analgesic efect of DEX has been confrmed in many previous studies [21][22][23], but the results of this study have once again demonstrated its excellent application potential, whereas the Ramsay and VAS scores of parturients in the low and medium-dose groups also reached an ideal state after anesthesia, with no evident diference in the number of CS conversions among the three groups, indicating that DEX of 0.5 and 0.75 μg/kg can also meet the need of labor analgesia.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy and Safety of Different Doses of Dexmedetomidine for Epidural Labor Analgesia

Zhang

Kong

et al. 2023

Emergency Medicine International

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Objective. To explore the efficacy and safety of different doses of dexmedetomidine (DEX) for epidural labor analgesia (ELA). Methods. From June 2021 to June 2022, 147 parturients who underwent ELA in our hospital were selected and divided into low- (0.5 μg/kg DEX), medium- (0.75 μg/kg DEX), and high-dose (1.0 μg/kg DEX) groups (n = 49 for each) according to the random number table method. The analgesic effect was assessed using the Ramsay sedation score and Visual Analogue Scale (VAS), and the labor duration, mean arterial pressure (MAP), and heart rate (HR) before and after analgesia, vaginal bleeding within 2 h postpartum, and delivery outcomes (the cesarean section conversion rate and the neonatal Apgar score) were statistically analyzed. Furthermore, the incidence of adverse reactions was calculated, and maternal satisfaction with delivery was investigated. Results. After analgesia, the the Ramsay and labor duration were higher in the high-dose group than those in the low- and medium-dose groups, and the VAS scores was lowerin the high-dose group than those in the low- and medium-dose groups P < 0.05 , while no difference was identified among the three groups in terms of the cesarean section conversion rate and the neonatal Apgar score P > 0.05 . The high-dose group had the greatest fluctuations in MAP and HR levels before and after analgesia than the other two groups, with a higher incidence of adverse reactions P < 0.05 . Finally, the survey of delivery satisfaction showed no significant difference in delivery satisfaction among the three groups P > 0.05 . Conclusion. DEX has excellent performance in ELA, which can effectively relieve the pain of puerperae and shorten the labor process. Among them, low-dose DEX has higher safety and is recommended as the first choice. Trial Registrations. This trial is registered with ML2021073.

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Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial

Cited by 10 publications

References 0 publications

Application of Dexmedetomidine in Epidural Labor Analgesia

Application of Dexmedetomidine in Epidural Labor Analgesia

Evaluation of the Relationship between Baseline Autonomic Tone and Haemodynamic Effects of Dexmedetomidine

Comparison of Efficacy and Safety of Different Doses of Dexmedetomidine for Epidural Labor Analgesia

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