Efficacy of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia in abdominal surgery: A meta‐analysis of randomised controlled trials

Abstract

To assess the efficacy and safety of dexmedetomidine (DEX) as an adjuvant to local wound infiltration anaesthesia in abdominal surgery, we conducted this meta‐analysis. First, the systematic search strategy was performed on PubMed, Embase, and Cochrane Library and five randomised controlled trials (RCTs) involving 294 patients were included. Then, the outcome data were extracted from the studies and their effect sizes were calculated using Review Manager 5. As a result, the addition of DEX significantly reduced visual analogy scores at 6 hours after surgery (mean difference = −0.53[−0.82, −0.25], P < .001), 12 hours after surgery (mean difference = −0.39 [−0.73, −0.05]; P = .03), and 24 hours after surgery (mean difference = −0.20 [−0.29, −0.11], P < .001) and reduced total analgesic consumption within 24 hours after surgery (mean difference = −4.92 [−9.00, −0.84]; P = .02) compared with placebo groups. However, there was no difference in the incidence of postoperative nausea and vomiting (risk ratio = 0.68 [0.41, 1.14]; P = .14). In summary, DEX as a local anaesthetic adjuvant added for local wound infiltration anaesthesia in abdominal surgery could reduce visual analogy scores and postoperative analgesic consumption without changing incidence of postoperative nausea and vomiting.

Does Inhaled Methoxyflurane Implement Fast and Efficient Pain Management in Trauma Patients? A Systematic Review and Meta-Analysis

“…The strengths of this meta-analysis include a pre-registered protocol, the comprehensive search strategy, and conservative GRADE assessment of certainty of evidence. The results were cautiously interpreted in the context of clinically important differences [32,55,56], allowing a meaningful estimate of the efficacy of methoxyflurane. Additionally, the adjusted statistical threshold for primary outcomes served to reduce the risk of type I error and multiple testing bias [32,38].…”

Efficacy and safety of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia: A meta‐analysis with trial sequential analysis of 23 randomised controlled trials

“…Second, in this meta‐analysis, we analysed the results by TSA, sensitivity analysis, subgroup analysis, publication bias (including trim‐and‐fill computation), and GRADE rating to further appraise the robustness of the results and provide ideas for future research directions. Last, compared with our previous meta‐analysis, 8 we comprehensively evaluated the safety of DEX in this study, which is profoundly significant for clinical medication.…”

“…Our research has several advantages and potential limitations. First, this research is based on a meta‐analysis conducted by our team that is in previous study, 8 and our interpretation of the results is cautious; the GRADE rating of the evidence base is conservative. Second, in this meta‐analysis, we analysed the results by TSA, sensitivity analysis, subgroup analysis, publication bias (including trim‐and‐fill computation), and GRADE rating to further appraise the robustness of the results and provide ideas for future research directions.…”

“…Although this meta‐analysis favoured DEX, the type of surgery examined was limited to abdominal surgery. In addition, DEX‐related adverse reactions such as bradycardia and hypotension were not evaluated, and no trial sequential analysis (TSA) was conducted 8 . These important topics have not been fully elucidated, and thus, it is important to further investigate the efficacy and safety of DEX in wound infiltration.…”

Nalbuphine Versus Ketorolac as an Adjuvant to Local Wound Infiltration Anesthesia in Open Colorectal Surgery: A Prospective Randomized Controlled Study

“…Improvement in perioperative pain is more valuable than immediate postoperative pain relief [5,6]. To address these issues, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), dexmedetomidine, dexamethasone, ketamine, and magnesium are often used as adjuvants to local anesthetics to prolong the duration and enhance LWI efficacy [3,7,8].…”