α-2 agonists vs. fentanyl as adjuvants for spinal anesthesia in elective cesarean section: a meta-analysis

VIA, Luigi LA; SANTONOCITO, Cristina; BARTOLOTTA, Nicola; LANZAFAME, Bruno; MORGANA, Alberto; CONTINELLA, Carlotta; CIRICA, Giulia; ASTUTO, Marinella; SANFILIPPO, Filippo

doi:10.23736/s0375-9393.22.16969-5

Cited by 14 publications

(15 citation statements)

References 44 publications

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“…However, post-spinal hypotension, relatively short duration,not sufficient postoperative analgesia are all the drawbacks of SA. A series of measures can compensate for the shortcomings of SA, such as neuraxial administration of opioids or a2 adrenergic receptor agonists, reducing the dosage of bupivacaine, can prolong the time for the first rescue analgesia, and reduce the occurrence of intraoperative hypotension [ 28 , 29 ]. Unfortunately, these measures are not routinely performed in our hospital, so no drugs other than local anesthetics were added into the subarachnoid space in this study.…”

Section: Discussionmentioning

confidence: 99%

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

Xu,

Yang,

et al. 2024

BMC Anesthesiol

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Background Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and more attention in society. Ketamine has been confirmed for its rapid antidepressant effect in women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence of PPD. Methods All the parturients enrolled in the study were randomly assigned to two groups: the esktamine group (0.2 mg/kg esketamine) and the control group (a same volume of saline). All the drugs were pumped for 40 min started from the beginning of the surgery. The Amsterdam Anxiety and Information Scale (APAIS) scores before the surgery, the Edinburgh postnatal depression scale (EPDS) scores at 4 d and 42 d after surgery, the Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, 24 h and 48 h post-operation were evaluated, as well as the adverse reactions were recorded. Results A total of 319 parturients were analyzed in the study. The incidence of PPD (EPDS score > 9) in the esketamine group was lower than the control group at 4 days after surgery (13.8% vs 23.1%, P = 0.0430) but not 42 days after surgery (P = 0.0987). Esketamine 0.2 mg/kg could reduce the NRS score at 6 h,12 h and 24 h after surgery, as well as the use of vasoactive drugs during surgery (P < 0.05). The incidences of maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) and drowsiness (3.8%) in the esketamine group were higher than those of control group (P < 0.05). Conclusions Intraoperative injection of esketamine (0.2 mg/kg) prevented the occurrence of depression (EPDS score > 9) at 4 days after delivery but not 42 days. Esketamine reduced the NRS scores at 6 h, 12 h and 24 h after surgery, but the occurrence of maternal side effects such as dizziness, blurred vision, drowsiness and hallucination were increased. Trial registration Registered in the Chinese Clinical Trial Registry (ChiCTR2100053422) on 20/11/2021.

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Section: Discussionmentioning

confidence: 99%

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

Xu,

Yang,

et al. 2024

BMC Anesthesiol

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“…Dexmedetomidine is a highly selective α2 agonist which has arousal sedation effects, analgesic, and anti-sympathetic effects. Compared to intrathecal opioids, the intrathecal use of dexmedetomidine can reduce respiration depression, nausea, vomiting, shivering and other drawbacks associated with opioids [ 1 , 16 , 17 ]. Intrathecally used dexmedetomidine in combination with local anesthetics has been proved to enhance intraoperative anesthetic effects of neuraxial anesthesia and improved maternal satisfaction after cesarean section [ 18 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section

Liu,

Chen,

Guo

2024

BMC Anesthesiol

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Background Dexmedetomidine has arousal sedation and analgesic effects. We hypothesize that epidural dexmedetomidine in single-dose combined with ropivacaine improves the experience of parturient undergoing cesarean section under epidural anesthesia. This study is to investigate the effect of 0.5 µg/kg epidural dexmedetomidine combined with epidural anesthesia (EA) in parturients undergoing cesarean section. Methods A total of 92 parturients were randomly divided into Group R (receiveing epidural ropivacaine alone) Group RD (receiveing epidural ropivacaine with 0.5 µg/kg dexmedetomidine). The primary outcome and second outcome will be intraoperative NRS pain scores and Ramsay Sedation Scale. Results All 92 parturients were included in the analysis. The NRS were significantly lower in Group RD compared to Group R at all observation timepoint (P > 0.05). Higher Ramsay Sedation Scale was found in Group RD compared to Group R (P < 0.001). No parturient has experienced sedation score of 4 and above. No significant difference regarding the incidence of hypotension, bradycardia and nausea or vomiting, Apgar scores and the overall satisfaction with anesthesia was found between Group R and Group RD (P > 0.05). Conclusion Epidural dexmedetomidine of 0.5 µg/kg added slightly extra analgesic effect to ropivacaine in EA for cesarean section. The sedation of 0.5 µg/kg epidural dexmedetomidine did not cause mother-baby bonding deficit. Satisfaction with anesthesia wasn’t significantly improved by epidural dexmedetomidine of 0.5 µg/kg. No additional side effect allows larger dose of epidural dexmedetomidine attempt. Trial registration This study was registered at www.chictr.org.cn (ChiCTR2000038853).

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“…Several studies have reported positive results, including a prolonged block duration, effective postoperative pain relief, and increased patient satisfaction [26][27][28]. As a result, dexmedetomidine as an adjuvant has garnered attention for its potential to improve the overall patient experience during and after surgical procedures in different settings, including regional and epidural anesthesia and analgesia [29,30]. In the context of epidural analgesia and anesthesia, dexmedetomidine as an adjuvant has been subjected to a meta-analysis, confirming its general safety and tolerability.…”

Section: Introductionmentioning

confidence: 99%

“…Concerning regional anesthesia and analgesia, it has shown superiority over fentanyl in elective cesarean sections by increasing the time to first rescue analgesia and prolonging the duration of the sensory block [29]. Additionally, a study by Schittek et al provided data on TKA patients who received USRA with FNB and SNB as well as LIA with dexmedetomidine as an adjuvant in both groups [18].…”

Section: Introductionmentioning

confidence: 99%

Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years

Reinbacher,

Schittek,

Draschl

et al. 2023

JCM

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Background: This study aimed to compare local periarticular infiltration (LIA) with ultra-sound guided regional anesthesia (USRA) with ropivacaine and dexmedetomidine as an additive agent in primary total knee arthroplasty (TKA). Methods: Fifty patients were randomized into two groups in a 1:1 ratio. Patients in the LIA group received local periarticular infiltration into the knee joint. The USRA group received two single-shot USRA blocks. Functional outcomes and satisfaction (range of movement, Knee Society Knee Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Knee Score, and Forgotten Joint Score), including well-being, were analyzed preoperatively and at five days, six weeks, and one and two years postoperatively. Results: Functional outcomes did not significantly differ between the two groups at six weeks and one and two years after the implementation of TKA. A moderate correlation was observed in the LIA group regarding well-being and pain on day five. Six weeks postoperatively, the LIA group showed significantly superior well-being but worse pain scores. No differences between the groups in well-being and functional outcomes could be observed one and two years postoperatively. Conclusion: Patients treated with LIA had superior postoperative well-being in the early postoperative phase of up to six weeks. Furthermore, LIA patients had similar functionality compared to patients treated with USRA but experienced significantly more pain six weeks postoperatively. LIA leads to improved short-term well-being, which is potentially beneficial for faster knee recovery. We believe that LIA benefits fast-track knee recovery with respect to improved short-term well-being, higher practicability, and faster application.

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α-2 agonists vs. fentanyl as adjuvants for spinal anesthesia in elective cesarean section: a meta-analysis

Cited by 14 publications

References 44 publications

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

Effect of epidural dexmedetomidine in single-dose combined with ropivacaine for cesarean section

Local Periarticular Infiltration with Dexmedetomidine Results in Superior Patient Well-Being after Total Knee Arthroplasty Compared with Peripheral Nerve Blocks: A Randomized Controlled Clinical Trial with a Follow-Up of Two Years

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