The efficacy and safety of clonidine and dexmedetomidine as an adjuvant in supraclavicular brachial plexus block for elective upper limb surgery

Tilkar, Yogesh; Agarwal, Sanjit; Gupta, Rahul; Karmalkar, Sanjeevani; Khatri, Prabha; Gupta, Neeta

doi:10.5455/ijmsph.2017.0513713062017

Cited by 1 publication

(10 citation statements)

References 19 publications

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“…The full‐text manuscripts of the remaining 312 studies were assessed. After including studies from hand searches and revision of search, we identified a total of 100 studies for inclusion in this network meta‐analysis [32–131]. The study flow chart is in online Supporting Information Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…For motor block duration, 23 studies were judged to be at low risk of bias [32, 35, 38, 39, 42, 45, 53, 54, 56, 59, 65, 76, 81, 82, 92–94, 107, 110, 113, 115, 116], 67 studies were at some risk of bias [33, 34, 36, 37, 40, 43, 48, 50–52, 55, 57, 58, 60–62, 67, 68, 70–75, 77–80, 83–91, 95–106, 108, 109, 111, 114, 117–126, 128–131] and 3 studies were at high risk of bias [41, 63, 127]. The provision of inadequate detail about randomisation and allocation concealment was the most common reason for downgrading the rating, followed by concerns relating to outcome measurement.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, pairwise meta‐analysis of 53 trials for sensory block duration [73–111, 113–122, 125, 126, 128, 129] and 53 trials for motor block duration [73–111, 113–122, 125, 126, 128, 129] comparing perineural dexmedetomidine vs. control arms did not reveal any sub‐group differences by indexing status (see online Supporting Information). Consequently, indexed and non‐indexed papers were pooled and analysed in the network, as decided a priori.…”

Section: Resultsmentioning

confidence: 99%

“…We included 93 trials (n = 5668) in the network meta‐analysis for motor block duration [32–43, 45, 48, 50–63, 65, 67, 68, 70–111, 113–131]. The mean (95%CI) duration of motor block in the control group was 369 (330‐408) min.…”

Section: Resultsmentioning

confidence: 99%

“…126,130,131]. Fifty-four trials used bupivacaine as their long-acting local anaesthetic[32-35, 38, 40-44, 46-48, 50, 51, 54, 55, 57-59, 61, 62, 64-66, 68-72, 76, 77, 79, 85, 89- 91, 93, 94, 98-101, 103, 104, 106, 112, 116-118, 122, 124- 126], 14 used levobupivacaine[37, 45, 63, 73, 78, 82, 83, 86, Twenty-three trials used lidocaine in the local anaesthetic admixture[33, 41, 44, 46-48, 50, 51, 57, 62, 64, 66, 69, 89, 90, 98, 99, 101, 104, 112, 113, 115, 124], while 15 added epinephrine to the local anaesthetic[41,42,44,47,48,51,57,62,66,69,89,90,112,113,124]. 116], 61 studies had some risk of bias[33,34,36,37, 43, 47, 48, 52, 55, 57, 58, 61, 67, 68, 70, 71, 73-75, 77-80, 83-85, 87-91, 95-106, 108, 109, 111, 114, 117-123, 125-131] and 4 studies were at high risk of bias[41,63,86,124].Figure 1Similarly, pairwise meta-analysis of 53 trials for sensory block duration[73-111, 113-122, 125, 126, 128, 129] and 53 trials for motor block duration[73-111, 113- 122, 125, 126, 128, 129] comparing perineural dexmedetomidine vs. control arms did not reveal any sub-group differences by indexing status (see online Supporting Information).…”

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confidence: 99%

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Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block

et al. 2020

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Both perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta-analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long-acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2-h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One-hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366-435) min, motor block duration of 369 (330-408) min and analgesic duration of 435 (386-483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160-795) min], followed by perineural dexamethasone [411 (343-480) min] and perineural dexmedetomidine [284 (235-333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236-352) min], followed by intravenous dexamethasone [289 (129-448)min] and perineural dexmedetomidine [258 (212-304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448-589) min], followed by intravenous dexamethasone [478 (277-679) min] and perineural dexmedetomidine [318 (266-371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.

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Section: Resultsmentioning

confidence: 99%