Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background. This study aims to determine the analgesic effect and safety of dexmedetomidine as an adjuvant to epidural local anesthetics during labor. Methods. Randomized controlled trials comparing epidural blocks with or without dexmedetomidine for labor analgesia were comprehensively searched. Review manager 5.4 was used to analyze the extracted data. Results. Compared with placebo and opioids, dexmedetomidine relieved labor pain of 15 min ( P = 0.002 ), 30 min ( P = 0.01 ), and 120 min ( P = 0.02 ) after block and at the moment of fetal disengagement ( P = 0.0002 ), decreased mean arterial pressure of 120 min ( P = 0.01 ), heart rate of 30 min ( P = 0.003 ), 60 min ( P < 0.00001 ), and 120 min ( P < 0.00001 ) after block, blood loss ( P = 0.02 ), and the incidence of nausea/vomiting ( P = 0.006 ), and increased the incidence of maternal bradycardia ( P = 0.04 ). However, sensitivity analysis only found that the incidence of nausea/vomiting was significantly different. Compared with placebo, dexmedetomidine relieved labor pain of 30 min after block ( P < 0.00001 ) and did not increase the incidences of side effects, but only two studies were enrolled. Compared with opioids, dexmedetomidine decreased the incidence of nausea/vomiting ( P = 0.002 ), increased the incidence of maternal bradycardia ( P = 0.04 ), and had a similar effect on labor pain relief; however, sensitivity analysis found that significant difference existed only at the incidence of nausea/vomiting. Other outcomes from meta-analysis or subgroup analysis were not different. Conclusions. Epidural dexmedetomidine has the potential to offer a better analgesic effect than placebo, similar labor pain control to opioids, and has no definite adverse effects on the parturient or fetus, but more high-quality studies are needed to confirm these conclusions.

The Influence of Dexmedetomidine as an Adjuvant in Intrathecal Labor Analgesia: A Multicenter Study on Efficacy and Maternal Satisfaction

“…Li et al observed that, compared with opioids, DEX reduced the incidence of nausea/vomiting but increased the incidence of maternal bradycardia, with a comparable relief of labor pain. 13 Furthermore, their latest study also revealed no differences in the effects of these 2 drugs on other outcomes. In this study, the incidence of bradycardia (heart rate 15% or more below the basal value) was also found to be higher in the S0.3 group than in the other 3 groups (P < .05).…”

“…In the present study, DEX was ineffective in diminishing the incidence of postpartum urinary retention in parturients with labor analgesia. Li et al observed that, compared with opioids, DEX reduced the incidence of nausea/vomiting but increased the incidence of maternal bradycardia, with a comparable relief of labor pain 13 . Furthermore, their latest study also revealed no differences in the effects of these 2 drugs on other outcomes.…”

Determination of the Dose-Response Relationship of Epidural Dexmedetomidine Combined with Ropivacaine for Labor Analgesia

“… 4 , 5 Dexmedetomidine can effectively enhance epidural labor analgesia by taking effect on α-2 receptors in the spinal dorsal horn and decrease the incidence of opioid-related adverse effects. 6 , 8 , 9 , 16 It has been reported that dexmedetomidine has better analgesic effect than sufentanil in the first labor process and analgesic effect. 9 , 17 A low dose dexmedetomidine (≤ 0.5 μg/mL) resulted in dose-sparing effects of local anesthetic, which may decrease the incidence of motor block and assisted vaginal delivery.…”