REVIEW   Free access

Minerva Anestesiologica 2021 September;87(9):1034-41

DOI: 10.23736/S0375-9393.21.15469-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Wound infiltration of dexmedetomidine as an adjunct to local anesthesia in postoperative analgesia for lumbar surgery

Hui DONG ^{1, 2}, Hongtao LIU ^{1, 3}, Dongming ZHU ^{1, 2}, Binjia RUAN ^{1, 2}, Hang YU ², Xiaohang XU ², Yongxiang WANG ² ✉

¹ Department of Graduate School, Dalian Medical University, Dalian, China; ² Department of Orthopedics, Clinical Medical College, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou, China; ³ Department of Urology, Clinical Medical College, Northern Jiangsu People’s Hospital, Yangzhou University, Yangzhou, China

INTRODUCTION: Most patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery.
EVIDENCE ACQUISITION: Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms “dexmedetomidine,” “infiltration,” and “lumbar.” The random-effect model was used to perform the meta-analysis based on deviance information criteria.
EVIDENCE SYNTHESIS: Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with dexmedetomidine significantly reduced the postoperative VAS scores (4^th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; P=0.0003); 24^th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; P<0.00001); 6th hour dynamic VAS scores (MD=-1.84; 95% CI: -2.23 to -1.45; P<0.00001) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; P<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95% CI:2.31 to 4.76; P<0.00001), and reduced the incidence of nausea or vomiting (RR=0.40; 95% CI: 0.17 to 0.93; P<0.05).
CONCLUSIONS: Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.

KEY WORDS: Dexmedetomidine; Lumbosacral region; Wounds and injuries; Meta-analysis