DG Journal Club
AUTHORS: Yan Sun, Zhilin Wu, ShuJun Sun, Rui Chen
J Clin Pharmacol. 2022 Feb 27 [Epub ahead of print]
Dexmedetomidine has been identified as a useful adjunct to improve the effect of nerve blocks in adults, however, its effect for children is not fully investigated. This meta-analysis is aimed to evaluate the reliability and efficacy of dexmedetomidine as a local anesthetics adjunct for pediatric surgeries. Eligible studies were searched in Cochrane, Embase, PubMed and CBM. The RevMan 5.4 was used to assess the risk of bias of each study and perform statistical analysis. Stata 15.0 was used to evaluate the publication bias of primary outcomes. Thirteen RCTs involving 722 patients aged 6 months to 12 years were harvested Statistical analysis showed that dexmedetomidine resulted in significantly longer duration of analgesia (standardized mean difference [SMD], 7.16; 95% confidence interval [CI], 4.88 to 9.43; P<0.001, I 2 = 98%); reducing the 1-h pain score (mean difference [MD], -0.27; 95% CI, -0.47 to -0.06; P = 0.01; I 2 = 28%), the cumulative doses of rescue analgesic requirements: 2 doses (risk ratio [RR], 0.26; 95% CI, 0.14 to 0.49; P<0.001, I 2 = 0), 3 doses (RR, 0.04; 95% CI, 0.01 to 0.16; P<0.001, I 2 = 4%), and the frequency of emergence agitation (RR, 0.44; 95% CI, 0.22 to 0.91; P = 0.03, I 2 = 0); shortening the onset time of blocks (MD, -3.56; 95% CI, -6.39 to -0.74; P = 0.01; I 2 = 90%). However, the incidence of some side effects, including hypotension, bradycardia, nausea and vomiting, pruritis, urinary retention, and respiratory depression, was not significantly different between dexmedetomidine group and placebo. Therefore, dexmedetomidine is a reliable and efficient adjunct to local anesthetics in children.
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