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Minerva Anestesiologica 2021 May 13

DOI: 10.23736/S0375-9393.21.15469-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Wound infiltration of dexmedetomidine as an adjunct to local anesthesia in postoperative analgesia for lumbar surgery: a systematic review and meta-analysis

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, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China; 3 Department of Urology, Northern Jiangsu People’s Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China


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INTRODUCTION: The vast majority of 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 (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; p=0.0003); 24th 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; Infiltration; Lumbar; Wound; Meta-analysis

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