The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background Dexmedetomidine (DEX) has been thought to be an effective adjuvant to local anesthetics (LAs) in erector spinae plane block (ESPB), however, this method of use is not recorded in the drug instructions. Hence, our meta-analysis will evaluate its efficacy and safety for the first time. Methods A systematic search of published articles was conducted in the PubMed, Embase, Web of science, and Cochrane Library databases up to July 17, 2022, using specific keywords related to our aims. The time first to request rescue analgesia, number of patient controlled intravenous analgesia (PCIA) presses, rate of rescue analgesia use, postoperative nausea and vomiting (PONV), arrhythmia, and hypotension were calculated by using random-effect models. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42022345488). Results Numerous electronic databases were searched and finally 8 studies with a total of 570 patients, 303 in the DEX arm, 267 in the control arm were included. As an adjuvant to LAs, DEX significantly increased the time to first request of rescue analgesia (mean difference [MD] = 8.40, 95% confidence interval [CI] = 4.70–12.10, P < 0.00001), reduced the number of PCIA presses (MD = -4.12, 95% CI = -7.79 to -0.45, P = 0.03) and the rate of rescue analgesia (odds ratio [OR] = 0.33, 95% CI = 0.17–0.65, P = 0.002). Moreover, the combination reduced the risk of PONV (OR = 0.57, 95% CI = 0.36–0.91, P = 0.02). In addition, there was no difference in the incidence of hypotension (OR = 1.01, 95% CI = 0.37–2.74, P = 0.99) and arrhythmia (OR = 0.76, 95% CI = 0.19–3.07, P = 0.70). Conclusion DEX can reduce analgesic requirements after various surgical procedures when used as an adjuvant to LAs for ESPB. Moreover, there was no significant difference between the two groups in terms of safety indicators (arrhythmia, hypotension).

Dexmedetomidine for Preventing Sleep Disturbance after Ambulatory Anesthesia: A Case Report

“…Comparable sleep alterations have not been documented with dexmedetomidine administration (Figure). 6,7 A recent meta-analysis of 5 randomized controlled trials (381 adults total) compared the sleep quality of patients who received dexmedetomidine pre-, peri-, or postoperatively to either placebo or other analgesics or sedating medications after elective surgery. Significant sleep quality improvements were observed in sleep efficiency (ratio of total sleep time/ time observed) and arousal (arousals per hours of sleep) indices, as well as decreased "light" (stage 1) and increased "deeper" (stage 2) sleep among those who received dexmedetomidine.…”

“…The study revealed no differences with respect to stage 3 or REM sleep. 6 A randomized, double-blind, placebo-controlled study by Wu et al 7 examined intraoperative dexmedetomidine infusion versus saline for 96 adults undergoing endoscopic sinus surgery. Each patient was observed for 1 night both preoperatively and postoperatively, where sleep architecture independent of sedating medications was analyzed using polysomnography.…”

“…1,2 Propofol exposure has been shown to impair sleep quality, [3][4][5] whereas similar effects have not been observed with dexmedetomidine administration. 6,7 Propofol-induced sleep disturbance may be related to circadian rhythm alterations at the level of the suprachiasmatic nuclei (SCN) and impaired melatonin production. 8 Circadian rhythm sleep-wake disorders are known to be common among patients with autism spectrum disorder (ASD).…”

“…6,11 This mechanism, in combination with its favorable effects on postsurgical inflammation, pain, and delirium, may improve postoperative sleep patterns. 6,7,11 Sleep disturbances after ambulatory procedures have also been documented; 4 however, the true incidence and severity are difficult to quantify given insufficient followup. We report the case of a 24-year-old man with a history of ASD, who experienced a propofol-induced exacerbation of an underlying sleep-onset disorder that did not recur with the primary use of dexmedetomidine during an outpatient procedure.…”

“…10 In contrast, dexmedetomidine's alpha-2 agonism within the brainstem's locus coeruleus is believed to exert sedative effects via an endogenous sleep pathway more closely resembling physiologic sleep. 6,11 This mechanism, in combination with its favorable effects on postsurgical inflammation, pain, and delirium, may improve postoperative sleep patterns. 6,7,11 Sleep disturbances after ambulatory procedures have also been documented; 4 however, the true incidence and severity are difficult to quantify given insufficient followup.…”