Efficacy and safety of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia: A meta‐analysis with trial sequential analysis of 23 randomised controlled trials

Abstract

To further identify the real efficacy and safety of dexmedetomidine as an adjuvant to local wound infiltration anaesthesia, we conducted this meta‐analysis. The systematic search strategy was performed using PubMed, Embase, Cochrane Library, and Chinese databases. As a result, a total of 23 RCTs (1445 patients) were included. Patients receiving dexmedetomidine combined with local anaesthetics had a lower rescue analgesia rate [risk ratio (RR): 0.48; 95% confidence interval (CI): 0.36‐0.65] and lower rescue analgesic consumption [weighted mean difference (WMD): −10.80 mg; 95%CI: −13.28 to −8.31 mg] than patients receiving local anaesthetics alone. The dexmedetomidine‐related adverse reactions included bradycardia (RR: 1.33; 95%CI: 0.32‐5.56) and hypotension (RR: 3.00; 95%CI: 0.49‐18.42). In addition, the time to first analgesic request (WMD: 296.16 minutes; 95%CI: 165.69 minutes ~ 426.63 minutes), incidence of postoperative nausea and vomiting (PONV) and pain scores at 4 hours postoperatively were also significantly lower in patients receiving dexmedetomidine combined with local anaesthetics. This meta‐analysis demonstrated that the use of dexmedetomidine as an adjuvant to wound infiltration is effective for reducing the rescue analgesia rate, rescue analgesic consumption and PONV. In addition, limited evidence shows that dexmedetomidine can prolong postoperative analgesia for approximately 5 hours. Further investigations on dexmedetomidine‐related adverse reactions and the dose–response effect of dexmedetomidine in wound infiltration are warranted.

Combined femoral and popliteal nerve block is superior to local periarticular infiltration anaesthesia for postoperative pain control after total knee arthroplasty

“…Some authors have stated that USRA is much more time-consuming compared with the easy-to-perform intraoperative LIA technique, resulting in fewer possible TKAs on a surgery day than usual when performing USRA [ 9 , 11 , 16 , 17 ]. In addition, LIA appears to be a more cost-effective technique [ 21 ]. Regarding adverse effects of dexmedetomidine for LIA or USRA, we no evidence for the concentration used could be found.…”

“…To date, the potential of dexmedetomidine as an adjuvant to LIA has not been investigated. If a dexmedetomidine-supplemented LIA could similarly enhance the analgesic efficacy of ropivacaine and prolong the duration of postoperative analgesia after TKA, as has already been described for wound infiltration, then this would be another strong argument for the use of LIA instead of USRA [ 15 , 21 ]. Thus, the primary goal of the present study was to evaluate dexmedetomidine as an adjuvant to LIA in TKA, when compared to the effect of single-shot femoral and popliteal blocks, both combined with dexmedetomidine, on postoperative opioid consumption.…”

Does Inhaled Methoxyflurane Implement Fast and Efficient Pain Management in Trauma Patients? A Systematic Review and Meta-Analysis

“…The strengths of this meta-analysis include a pre-registered protocol, the comprehensive search strategy, and conservative GRADE assessment of certainty of evidence. The results were cautiously interpreted in the context of clinically important differences [32,55,56], allowing a meaningful estimate of the efficacy of methoxyflurane. Additionally, the adjusted statistical threshold for primary outcomes served to reduce the risk of type I error and multiple testing bias [32,38].…”

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

“…For all continuous outcomes in this review, a mean and standard difference (SD) was extracted. The mean and SD were approximated using the median and interquartile range if its value was not available 13,14 . Besides, The GetData Graph Digitizer Software was used to generate the data in graphical form (GetData Pty Ltd., Kogarah, Australia).…”