Intrathecal dexmedetomidine and postoperative pain: A systematic review and meta‐analysis of randomized controlled trials. (22nd May 2020)

• Record Type: Journal Article
• Authors: Paramasivan, Ambika; Lopez‐Olivo, Maria A.; Foong, Theng W.; Tan, Yi W.; Yap, Andrea P. A.
• Is Part Of: European journal of pain. Volume 24:Number 7(2020)
• Page Start: 1215
• Page End: 1227
• Publication Date: 2020-05-22
• Subjects: Pain -- Periodicals; Pain -- Treatment -- Periodicals; Pain -- Physiological aspects -- Periodicals; 616.0472
• DOI: 10.1002/ejp.1575
• Languages: English
• ISSNs: 1090-3801

Abstract

Abstract: Background and Objective: A systematic review and meta‐analysis of randomized controlled trials (RCTs) was undertaken to evaluate the effect of intrathecal dexmedetomidine (DEX) on the duration of postoperative analgesia, postoperative pain scores and incidences of adverse effects. Databases and Data Treatment: Database search was performed from inception until January 2019. All RCTs analysing acute postoperative pain characteristics after intrathecal DEX administration in adults undergoing spinal anaesthesia for elective surgery were included. The primary outcome was postoperative analgesic duration, defined as the time to first analgesic request. The secondary outcomes included pain scores at 6, 12 and 24 postoperative hours and rates of hypotension, bradycardia, shivering and postoperative nausea and vomiting. Results: Twenty‐four studies comprising a total of 1, 460 patients were included. Postoperative analgesic duration was prolonged with intrathecal DEX compared to placebo, with a pooled mean difference (MD) of 191.3 min (95% CI 168.8–213.8). Patients who received intrathecal DEX reported lower Visual Analogue Scale scores at 24 postoperative hours compared with those patients receiving placebo, with a MD (95% CI) of −1.05 (−1.89 to −0.20, p = 0.02). There were no differences in the incidence of adverse effects, except for a lower rate of postoperative shivering in the intrathecal DEX group (pooled relative risk 0.58, 95% CI 0.34–0.98, p = 0.04). Conclusions: Compared to placebo, intrathecal DEX prolonged postoperative analgesic duration, reduced 24‐hr pain intensity and reduced the incidence of shivering without an increase in other adverse effects. Significance: The analgesic role of intrathecal DEX is promising due to its ability to significantly increase postoperative analgesic duration when compared with placebo. Its usage can be considered for patients undergoing surgeries with significant postoperative pain, particularly those intolerant of systemic analgesia. However, the optimal dose for various surgeries as well as its long‐term neurological effects warrants further studies.