Evidence basis for using dexmedetomidine to enhance the quality of paravertebral block: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Dexmedetomidine is considered an adjunct to local anaesthesia (LA) to prolong peripheral nerve block time. However, the results from a previous meta-analysis were not sufficient to support its use in paravertebral block (PVB). Therefore, we performed an updated meta-analysis to evaluate the efficacy of dexmedetomidine combined with LA in PVB.Methods: We performed an electronic database search from the date of establishment to April 2022. Randomized controlled trials (RCTs) investigating the combination of dexmedetomidine and LA compared with LA alone for PVB in adult patients were included. Postoperative pain scores, analgesic consumption, and adverse reactions were analyzed.Results: We identified 12 trials (701 patients) and found that the application of dexmedetomidine as a PVB adjunct reduced the postoperative pain severity of patients 12 and 24 h after surgery compared to a control group. Expressed as mean difference (MD) (95% CI), the results were −1.03 (−1.18, −0.88) (p < 0.00001, I2 = 79%) for 12 h and −1.08 (−1.24, −0.92) (p < 0.00001, I2 = 72%) for 24 h. Dexmedetomidine prolonged the duration of analgesia by at least 173.27 min (115.61, 230.93) (p < 0.00001, I2 = 81%) and reduced postoperative oral morphine consumption by 18.01 mg (−22.10, 13.92) (p < 0.00001, I2 = 19%). We also found no statistically significant differences in hemodynamic complications between the two groups. According to the GRADE system, we found that the level of evidence for postoperative pain scores at 12 and 24 h was rated as moderate.Conclusion: Our study shows that dexmedetomidine as an adjunct to LA improves the postoperative pain severity of patients after surgery and prolongs the duration of analgesia in PVB without increasing the incidence of adverse effects.

Effects of Ultrasound-Guided Thoracic Paravertebral Nerve Block Combined with Perineural or IV Dexmedetomidine on Acute and Chronic Pain After Thoracoscopic Resection of Lung Lesions: A Double-Blind Randomized Trial

“…19,21 This study revealed that compared with ropivacaine alone, perineural or IV dexmedetomidine can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, and reduce the consumption of intraoperative and postoperative OME, which was consistent with previous studies. 40 QoR-15 is a validated quality assessment tool, and the results demonstrated that perineural and IV dexmedetomidine can improve the QOD-15 score at POD1 compared with ropivacaine alone, which has achieved minimum clinically important difference (MCID) (6.0). 41 Another important result of our study was the effect of perineural dexmedetomidine compared to IV dexmedetomidine.…”