Shuyan Liu1, Peng Zhao2, Yunfeng Cui2, Chang Lu2, Mingxin Ji2, Wenhua Liu2, Wei Jiang2, Zhuo Zhu2, Qianchuang Sun3. 1. Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China. 2. Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China. 3. Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, China. Electronic address: sunqianchuang@163.com.
Abstract
PURPOSE: Intrathecal dexmedetomidine (DEX) has been used to improve the quality and duration of spinal anesthesia. The aim of this meta-analysis is to evaluate whether intrathecal DEX could prolong the duration of sensory and motor block during spinal anesthesia. METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials that investigated the facilitatory effects of intrathecal administration of DEX compared with those of a placebo on spinal anesthesia from inception to April 2019. Sensory and motor block durations, sensory and motor block onset times, time to first analgesic request, and DEX-related adverse effects were evaluated. Results were combined using fixed-effects or random effects modeling when appropriate. FINDINGS: A total of 1478 patients from 25 clinical studies were included in the analysis. Compared with placebo, intrathecal DEX significantly prolonged the durations of both sensory block (weighted mean difference [WMD] = 134.42 min; 95% CI, 109.71-159.13 min; P < 0.001) and motor block (WMD = 114.27 min; 95% CI, 93.18-135.35 min; P < 0.001). It also hastened the onset of sensory block (WMD = -0.80 min; 95% CI, -1.21 to -0.40; P < 0.001) and motor block (WMD = -1.03 min; 95% CI, -1.51 to -0.56 min; P < 0.001). Furthermore, it delayed the time to first analgesic request (WMD = 216.90 min; 95% CI, 178.90-254.90 min; P < 0.001) and reduced the incidence of shivering (risk ratio [RR] = 0.39; 95% CI, 0.27-0.55; P < 0.001). DEX was associated with increased risk of transient bradycardia (RR = 1.59; 95% CI, 1.07-2.37; P = 0.022) and hypotension (RR = 1.40; 95% CI, 1.04-1.89; P = 0.026) but did not increase the incidence of postoperative nausea and vomiting (RR = 0.87; 95% CI, 0.62-1.24; P = 0.45). IMPLICATIONS: Intrathecal DEX can prolong the duration of sensory block, the duration of motor block, and the time to first analgesic request associated with spinal anesthesia.
PURPOSE: Intrathecal dexmedetomidine (DEX) has been used to improve the quality and duration of spinal anesthesia. The aim of this meta-analysis is to evaluate whether intrathecal DEX could prolong the duration of sensory and motor block during spinal anesthesia. METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for randomized controlled trials that investigated the facilitatory effects of intrathecal administration of DEX compared with those of a placebo on spinal anesthesia from inception to April 2019. Sensory and motor block durations, sensory and motor block onset times, time to first analgesic request, and DEX-related adverse effects were evaluated. Results were combined using fixed-effects or random effects modeling when appropriate. FINDINGS: A total of 1478 patients from 25 clinical studies were included in the analysis. Compared with placebo, intrathecal DEX significantly prolonged the durations of both sensory block (weighted mean difference [WMD] = 134.42 min; 95% CI, 109.71-159.13 min; P < 0.001) and motor block (WMD = 114.27 min; 95% CI, 93.18-135.35 min; P < 0.001). It also hastened the onset of sensory block (WMD = -0.80 min; 95% CI, -1.21 to -0.40; P < 0.001) and motor block (WMD = -1.03 min; 95% CI, -1.51 to -0.56 min; P < 0.001). Furthermore, it delayed the time to first analgesic request (WMD = 216.90 min; 95% CI, 178.90-254.90 min; P < 0.001) and reduced the incidence of shivering (risk ratio [RR] = 0.39; 95% CI, 0.27-0.55; P < 0.001). DEX was associated with increased risk of transient bradycardia (RR = 1.59; 95% CI, 1.07-2.37; P = 0.022) and hypotension (RR = 1.40; 95% CI, 1.04-1.89; P = 0.026) but did not increase the incidence of postoperative nausea and vomiting (RR = 0.87; 95% CI, 0.62-1.24; P = 0.45). IMPLICATIONS: Intrathecal DEX can prolong the duration of sensory block, the duration of motor block, and the time to first analgesic request associated with spinal anesthesia.