Effect of 5-μg Dose of Dexmedetomidine in Combination With Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis

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 DEXrelated 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] ¼ 134.42 min; 95% CI, 109.71e159.13 min; P < 0.001) and motor block (WMD ¼ 114.27 min; 95% CI, 93.18e135.35 min; P < 0.001). It also hastened the onset of sensory block (WMD ¼ −0.80 min; 95% CI, −1.21 to −0.40; P < 0.001) and motor block (WMD ¼ −1.03 min; 95% CI, −1.51 to −0.56 min; P < 0.001). Furthermore, it delayed the time to first analgesic request (WMD ¼ 216.90 min; 95% CI, 178.90e254.90 min; P < 0.001) and reduced the incidence of shivering (risk ratio [RR] ¼ 0.39; 95% CI, 0.27e0.55; P < 0.001). DEX was associated with increased risk of transient bradycardia (RR ¼ 1.59; 95% CI, 1.07e2.37; P ¼ 0.022) and hypotension (RR ¼ 1.40; 95% CI, 1.04e1.89; P ¼ 0.026) but did not increase the incidence of postoperative nausea and vomiting (RR ¼ 0.87; 95% CI, 0.62e1.24; P ¼ 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.

Successful Treatment of Refractory Cancer Pain and Depression with Continuous Intrathecal Administration of Dexmedetomidine and Morphine: A Case Report

“…DEX has been reported to be safe to use intrathecally. Previously published meta-analysis and reviews have shown that intrathecal infusions of DEX can shorten the onset time of spinal anesthesic as well as enhance and prolong their sensory and motor effects, and increasing the time to the need for pain rescue after spinal anesthesia [ 11 , 12 ]. Khosravi et al demonstrated that intrathecal DEX produced better outcomes in terms of analgesia, sedation, and hemodynamic parameters compared to intravenous DEX [ 13 ].…”

Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

“…18 The most representative intrathecal adjuvants in clinical practice for labor analgesia are opioids and a 2 -adrenergic receptor agonists. 19 In this study, compared with the use of 5 mg sufentanil intrathecally combined with 0.1% epidural ropivacaine þ 0.2 mg/mL sufentanil, the use of 5 mg Dex intrathecally combined with the epidural drugs described above offered similar pain relief during labor with less shivering and pruritus. Therefore, Dex is a good alternative in labor analgesia as an intrathecal drug combined with epidural analgesia.…”

Comparison of Dexmedetomidine Plus Bupivacaine Versus Bupivacaine Alone for Spinal Anesthesia in Patients Undergoing Abdominal Hysterectomy

“…15 Another study by Khan et al reported that the addition of Dexmedetomidine along with Bupivacaine is beneficial in terms of quicker onset and prolonged duration of analgesia. 16 However, these authors used 5µg Dexmedetomidine, and in the present study, we used 10µg Dexmedetomidine as an adjuvant. Other studies have also reported similar results.…”