American Society of Regional Anesthesia and Pain Medicine August 2018 - 35
Table 2: Meta-analyses of perioperative dexmedetomidine and its effect on analgesia.
Author, year
Study
Comparison
Conclusions
Lee, 2017
Meta-analysis of 13 studies in nasal
surgery
Dex compared with placebo or
remifentanil
Dex significantly reduced
postoperative pain.
Blaudszun, 2012
Meta-analysis of 30 randomized
controlled trials in noncardiac
surgery under general anesthesia
Systemic α-2 agonists compared
with placebo or no treatment
Perioperative α-2 agonists decrease
postoperative opioid consumption,
pain intensity, and nausea
Liu, 2017
Meta-analysis of 11 randomized
controlled trials in neurosurgery
Dex compared with placebo or
opioids
Dex reduced pain intensity and
perioperative opioid consumption
Bot, 2015
Meta-analysis of 18 randomized
controlled trials in adults
Dex compared with placebo
Dex reduced postoperative opioid
consumption and pain
Hussain, 2017
Meta-analysis of 18 randomized
controlled trials in brachial plexus
block
Dex as an adjuvant to local
anesthesia compared with local
anesthesia alone
Dex quickens the onset, prolongs
the duration of analgesia, and
reduces postoperative analgesic
consumption
Abdallah, 2013
Meta-analysis of nine randomized
controlled trials in surgical patients
undergoing regional anesthesia
Perineural Dex + local anesthesia
compared with local anesthesia
alone in neuraxial and peripheral
nerve blocks
Perineural Dex prolongs duration
of motor block and time to first
analgesic request in neuraxial and
brachial plexus block
Abbreviation: Dex, dexmedetomidine.
When examining outcomes following nasal surgery, Lee et al17
found reduced opioid consumption with systemic administration
of dexmedetomidine. Dexmedetomidine compared to placebo or
no treatment was investigated in three different meta-analyses
for various surgical procedures. All analyses found similar results,
including decreased opioid consumption and reduced pain or pain
intensity in the groups receiving dexmedetomidine.18-20
Dexmedetomidine has also been used as an adjuvant to local
anesthetics (LA). As an intrathecal or epidural adjuvant, it provides
better postoperative analgesia,4,6 and as an adjuvant in peripheral
nerve block and intravenous regional anesthesia, it has been
reported to shorten onset time, prolong duration of postoperative
analgesia, and improve block quality.6 Recently, Hussain et al21
reviewed the efficacy of dexmedetomidine as an adjuvant to
LA in brachial plexus blocks and found that dexmedetomidine
significantly shortened the block onset time by 3.2 minutes,
prolonged sensory blockade by 261 minutes, and prolonged the
duration of analgesia by 289 minutes.
Abdallah et al 22 examined the effects of perineural
dexmedetomidine as an LA adjuvant in neuraxial and brachial
plexus blocks compared with LA alone. As in the Hussain et al 21
meta-analysis, dexmedetomidine was found to increase the
duration of sensory block in brachial plexus analgesia; however,
the difference was not statistically significant. Motor block
duration and time to first analgesic request were prolonged in
both neuraxial and brachial plexus blocks. The prolongation of
motor blockade may offset the benefits of dexmedetomidine
if it delays rehabilitation or discharge, especially in the
ambulatory setting. Conclusive neurotoxicity data on perineural
dexmedetomidine use are lacking: some animal data suggest
dexmedetomidine is protective against hypoxic-ischemic
neuronal injury, whereas other studies have shown evidence of
demyelination in white matter when administered via the epidural
route. 6,22
The current literature on dexmedetomidine used perioperatively
suggests that in certain clinical scenarios, the drug decreases
perioperative opioid consumption and improves postoperative
analgesia. Of note, many of the studies have also shown that
perioperative dexmedetomidine use has a trend toward decreased
adverse side effects such as PONV when compared with other
commonly prescribed analgesic medications. More research is
warranted to establish the efficacy and safety of perioperative
dexmedetomidine for the management of acute pain and analgesia,
with a closer look at its utility in the postoperative period as well as
the ambulatory setting.
REFERENCES
1.
Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377:2215-
2225.
2.
Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute
postoperative pain. Curr Opin Anaesthesiol. 2009;22:588-593.
American Society of Regional Anesthesia and Pain Medicine
2018
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