Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis.
Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis.
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右美托咪定作为椎管内辅助剂是否有助于更好的麻醉和镇痛？
DOI：
10.1371/journal.pone.0093114
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Wang W
中科院分区：
文献类型：
--
作者：
Wu HH;Wang HT;Jin JJ;Cui GB;Zhou KC;Chen Y;Chen GZ;Dong YL;Wang W
背景：右美托咪定（dexmedetomidine，DEX）作为辅助镇痛药的神经轴索应用已经在一些随机对照试验（randomized controlled trials，RCT）中进行了研究，但由于这些RCT中疗效和安全性的不一致而未被批准。我们进行了这项荟萃分析，以评估neuraxial DEX作为局部麻醉（LA）辅助的有效性和安全性。方法：我们检索了PubMed、PsycINFO、Scopus、EMBASE和CENTRAL数据库，从开始到2013年6月，研究了DEX作为LA辅助剂的镇痛疗效和安全性的RCT。使用标准化平均差异（SMD）、加权平均差异（WMD）或比值比（OR）以及适当的效应模型总结效应。主要结局为术后疼痛强度和镇痛持续时间、心动过缓和低血压。结果共纳入16个随机对照试验，共1092例受试者。神经轴DEX显著降低术后疼痛强度（SMD，−1.29; 95%置信区间（CI），−1.70至−0.89; P<0.00001），镇痛持续时间延长（WMD，6.93小时; 95% CI，5.23至8.62; P<0.00001），并增加心动过缓的风险（OR，2.68; 95% CI，1.18至6.10; P = 0.02）。没有证据表明，轴突DEX增加其他不良事件的风险，如低血压（OR，1.54; 95%CI，0.83至2.85; P = 0.17）。 此外，轴索DEX与术后镇静评分和镇痛需求数量、感觉和运动阻滞特征以及术中血流动力学的有益改变相关。结论Neuaxial DEX是一种较好的LA辅助药物，镇痛效果更好，持续时间更长。最大的问题是心动过缓。需要进一步的大样本试验，严格的设计和关注长期结果。
Background Neuraxial application of dexmedetomidine (DEX) as adjuvant analgesic has been invetigated in some randomized controlled trials (RCTs) but not been approved because of the inconsistency of efficacy and safety in these RCTs. We performed this meta-analysis to access the efficacy and safety of neuraxial DEX as local anaesthetic (LA) adjuvant. Methods We searched PubMed, PsycINFO, Scopus, EMBASE, and CENTRAL databases from inception to June 2013 for RCTs that investigated the analgesia efficacy and safety for neuraxial application DEX as LA adjuvant. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMDs) or odds ratio (OR) with suitable effect model. The primary outcomes were postoperative pain intensity and analgesic duration, bradycardia and hypotension. Results Sixteen RCTs involving 1092 participants were included. Neuraxial DEX significantly decreased postoperative pain intensity (SMD, −1.29; 95% confidence interval (CI), −1.70 to −0.89; P<0.00001), prolonged analgesic duration (WMD, 6.93 hours; 95% CI, 5.23 to 8.62; P<0.00001) and increased the risk of bradycardia (OR, 2.68; 95% CI, 1.18 to 6.10; P = 0.02). No evidence showed that neuraxial DEX increased the risk of other adverse events, such as hypotension (OR, 1.54; 95% CI, 0.83 to 2.85; P = 0.17). Additionally, neuraxial DEX was associated with beneficial alterations in postoperative sedation scores and number of analgesic requirements, sensory and motor block characteristics, and intro-operative hemodynamics. Conclusion Neuraxial DEX is a favorable LA adjuvant with better and longer analgesia. The greatest concern is bradycardia. Further large sample trials with strict design and focusing on long-term outcomes are needed.
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影响因子：
4
作者：
Hozo SP;Djulbegovic B;Hozo I
通讯作者：
Hozo I
DOI：
10.1007/bf03021622
发表时间：
2006-07-01
期刊：
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
影响因子：
--
作者：
Gurbet, A;Basagan-Mogol, E;Ozcan, B
通讯作者：
Ozcan, B
影响因子：
8.8
作者：
Blaudszun, Gregoire;Lysakowski, Christopher;Tramer, Martin R.
通讯作者：
Tramer, Martin R.
影响因子：
8.8
作者：
Degos, Vincent;Le Charpentier, Tifenn;Gressens, Pierre
通讯作者：
Gressens, Pierre
影响因子：
9.8
作者：
El-Hennawy, A. M.;Abd-Elwahab, A. M.;Boulis, S. R.
通讯作者：
Boulis, S. R.