Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in brachial plexus block a systematic review and meta-analysis of 18 randomized controlled trials

Nasir Hussain, Vincent Paul Grzywacz, Charles Andrew Ferreri, Amit Atrey, Laura Banfield, Naum Shaparin, Amaresh Vydyanathan

Research output: Contribution to journalReview article

16 Citations (Scopus)

Abstract

Background and Objectives: Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. Methods: Ameta-analysis of randomized controlled trialswas conducted to assess the ability of dexmedetomidine to prolong the duration and hasten the onset of motor and sensory blockade when used as an adjuvant to local anesthesia for brachial plexus blockade versus using local anesthesia alone (control). A search strategy was created to identify eligible articles in MEDLINE, EMBASE, and The Cochrane Library. The methodological quality for each included study was evaluated using the Cochrane Tool for Risk of Bias. Results: Eighteen randomized controlled trials were included in this metaanalysis (n = 1092 patients). The addition of dexmedetomidine significantly reduced sensory block time onset time by 3.19 minutes (95% confidence interval [CI], -4.60 to -1.78 minutes; I2 = 95%; P < 0.00001), prolonged sensory block duration by 261.41 minutes (95% CI, 145.20-377.61 minutes; I2 = 100%; P < 0.0001), reduced the onset of motor blockade by 2.92minutes (95% CI, -4.37 to -1.46 minutes; I2 = 96%, P < 0.0001), and prolongedmotor block duration by 200.90 minutes (CI, 99.24-302.56 minutes; I2 = 99%; P = 0.0001) as compared with control. Dexmedetomidine also significantly prolonged the duration of analgesia by 289.31 minutes (95% CI, 185.97-392.64 minutes; I2 = 99%; P < 0.00001). Significantlymore patients experienced intraoperative bradycardia with dexmedetomidine (risk difference [RD], 0.06; 95% CI, 0.00-0.11; I2 = 72%; P = 0.03); however, there was no difference in the incidence of intraoperative hypotension (RD, 0.01; 95% CI, -0.02 to 0.04; I2 = 3%; P = 0.45). It is important to note that all studies reported that intraoperative bradycardia was either transient in nature or reversible, when needed, with the administration of intravenous atropine. Conclusions: Dexmedetomidine has the ability to hasten the onset and prolong the duration of blockade when used as an adjuvant to local anesthesia for brachial plexus blockade. Considering an analgesic effect to be either decreased pain, a longer duration of analgesic block, or decreased opioid consumption, the addition of dexmedetomidine to local anesthetics for brachial plexus blockade was found to significantly improve analgesia in all 18 included studies. However, patients receiving dexmedetomidine should be continuouslymonitored for the potentially harmful but reversible adverse effect of intraoperative bradycardia. Level of Evidence: Therapeutic, level I.

Original languageEnglish (US)
Pages (from-to)184-196
Number of pages13
JournalRegional Anesthesia and Pain Medicine
Volume42
Issue number2
DOIs
StatePublished - 2017

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Dexmedetomidine
Local Anesthesia
Meta-Analysis
Randomized Controlled Trials
Confidence Intervals
Bradycardia
Local Anesthetics
Analgesia
Analgesics
Aptitude
Brachial Plexus Block
Atropine
MEDLINE
Intravenous Administration
Hypotension
Opioid Analgesics
Libraries
Uncertainty
Pain
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Investigating the efficacy of dexmedetomidine as an adjuvant to local anesthesia in brachial plexus block a systematic review and meta-analysis of 18 randomized controlled trials. / Hussain, Nasir; Grzywacz, Vincent Paul; Ferreri, Charles Andrew; Atrey, Amit; Banfield, Laura; Shaparin, Naum; Vydyanathan, Amaresh.

In: Regional Anesthesia and Pain Medicine, Vol. 42, No. 2, 2017, p. 184-196.

Research output: Contribution to journalReview article

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abstract = "Background and Objectives: Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. Methods: Ameta-analysis of randomized controlled trialswas conducted to assess the ability of dexmedetomidine to prolong the duration and hasten the onset of motor and sensory blockade when used as an adjuvant to local anesthesia for brachial plexus blockade versus using local anesthesia alone (control). A search strategy was created to identify eligible articles in MEDLINE, EMBASE, and The Cochrane Library. The methodological quality for each included study was evaluated using the Cochrane Tool for Risk of Bias. Results: Eighteen randomized controlled trials were included in this metaanalysis (n = 1092 patients). The addition of dexmedetomidine significantly reduced sensory block time onset time by 3.19 minutes (95{\%} confidence interval [CI], -4.60 to -1.78 minutes; I2 = 95{\%}; P < 0.00001), prolonged sensory block duration by 261.41 minutes (95{\%} CI, 145.20-377.61 minutes; I2 = 100{\%}; P < 0.0001), reduced the onset of motor blockade by 2.92minutes (95{\%} CI, -4.37 to -1.46 minutes; I2 = 96{\%}, P < 0.0001), and prolongedmotor block duration by 200.90 minutes (CI, 99.24-302.56 minutes; I2 = 99{\%}; P = 0.0001) as compared with control. Dexmedetomidine also significantly prolonged the duration of analgesia by 289.31 minutes (95{\%} CI, 185.97-392.64 minutes; I2 = 99{\%}; P < 0.00001). Significantlymore patients experienced intraoperative bradycardia with dexmedetomidine (risk difference [RD], 0.06; 95{\%} CI, 0.00-0.11; I2 = 72{\%}; P = 0.03); however, there was no difference in the incidence of intraoperative hypotension (RD, 0.01; 95{\%} CI, -0.02 to 0.04; I2 = 3{\%}; P = 0.45). It is important to note that all studies reported that intraoperative bradycardia was either transient in nature or reversible, when needed, with the administration of intravenous atropine. Conclusions: Dexmedetomidine has the ability to hasten the onset and prolong the duration of blockade when used as an adjuvant to local anesthesia for brachial plexus blockade. Considering an analgesic effect to be either decreased pain, a longer duration of analgesic block, or decreased opioid consumption, the addition of dexmedetomidine to local anesthetics for brachial plexus blockade was found to significantly improve analgesia in all 18 included studies. However, patients receiving dexmedetomidine should be continuouslymonitored for the potentially harmful but reversible adverse effect of intraoperative bradycardia. Level of Evidence: Therapeutic, level I.",
author = "Nasir Hussain and Grzywacz, {Vincent Paul} and Ferreri, {Charles Andrew} and Amit Atrey and Laura Banfield and Naum Shaparin and Amaresh Vydyanathan",
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AU - Hussain, Nasir

AU - Grzywacz, Vincent Paul

AU - Ferreri, Charles Andrew

AU - Atrey, Amit

AU - Banfield, Laura

AU - Shaparin, Naum

AU - Vydyanathan, Amaresh

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N2 - Background and Objectives: Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. Methods: Ameta-analysis of randomized controlled trialswas conducted to assess the ability of dexmedetomidine to prolong the duration and hasten the onset of motor and sensory blockade when used as an adjuvant to local anesthesia for brachial plexus blockade versus using local anesthesia alone (control). A search strategy was created to identify eligible articles in MEDLINE, EMBASE, and The Cochrane Library. The methodological quality for each included study was evaluated using the Cochrane Tool for Risk of Bias. Results: Eighteen randomized controlled trials were included in this metaanalysis (n = 1092 patients). The addition of dexmedetomidine significantly reduced sensory block time onset time by 3.19 minutes (95% confidence interval [CI], -4.60 to -1.78 minutes; I2 = 95%; P < 0.00001), prolonged sensory block duration by 261.41 minutes (95% CI, 145.20-377.61 minutes; I2 = 100%; P < 0.0001), reduced the onset of motor blockade by 2.92minutes (95% CI, -4.37 to -1.46 minutes; I2 = 96%, P < 0.0001), and prolongedmotor block duration by 200.90 minutes (CI, 99.24-302.56 minutes; I2 = 99%; P = 0.0001) as compared with control. Dexmedetomidine also significantly prolonged the duration of analgesia by 289.31 minutes (95% CI, 185.97-392.64 minutes; I2 = 99%; P < 0.00001). Significantlymore patients experienced intraoperative bradycardia with dexmedetomidine (risk difference [RD], 0.06; 95% CI, 0.00-0.11; I2 = 72%; P = 0.03); however, there was no difference in the incidence of intraoperative hypotension (RD, 0.01; 95% CI, -0.02 to 0.04; I2 = 3%; P = 0.45). It is important to note that all studies reported that intraoperative bradycardia was either transient in nature or reversible, when needed, with the administration of intravenous atropine. Conclusions: Dexmedetomidine has the ability to hasten the onset and prolong the duration of blockade when used as an adjuvant to local anesthesia for brachial plexus blockade. Considering an analgesic effect to be either decreased pain, a longer duration of analgesic block, or decreased opioid consumption, the addition of dexmedetomidine to local anesthetics for brachial plexus blockade was found to significantly improve analgesia in all 18 included studies. However, patients receiving dexmedetomidine should be continuouslymonitored for the potentially harmful but reversible adverse effect of intraoperative bradycardia. Level of Evidence: Therapeutic, level I.

AB - Background and Objectives: Dexmedetomidine has been thought to be an effective adjuvant to local anesthetics in brachial plexus blockade. We sought to clarify the uncertainty that still exists as to its true efficacy. Methods: Ameta-analysis of randomized controlled trialswas conducted to assess the ability of dexmedetomidine to prolong the duration and hasten the onset of motor and sensory blockade when used as an adjuvant to local anesthesia for brachial plexus blockade versus using local anesthesia alone (control). A search strategy was created to identify eligible articles in MEDLINE, EMBASE, and The Cochrane Library. The methodological quality for each included study was evaluated using the Cochrane Tool for Risk of Bias. Results: Eighteen randomized controlled trials were included in this metaanalysis (n = 1092 patients). The addition of dexmedetomidine significantly reduced sensory block time onset time by 3.19 minutes (95% confidence interval [CI], -4.60 to -1.78 minutes; I2 = 95%; P < 0.00001), prolonged sensory block duration by 261.41 minutes (95% CI, 145.20-377.61 minutes; I2 = 100%; P < 0.0001), reduced the onset of motor blockade by 2.92minutes (95% CI, -4.37 to -1.46 minutes; I2 = 96%, P < 0.0001), and prolongedmotor block duration by 200.90 minutes (CI, 99.24-302.56 minutes; I2 = 99%; P = 0.0001) as compared with control. Dexmedetomidine also significantly prolonged the duration of analgesia by 289.31 minutes (95% CI, 185.97-392.64 minutes; I2 = 99%; P < 0.00001). Significantlymore patients experienced intraoperative bradycardia with dexmedetomidine (risk difference [RD], 0.06; 95% CI, 0.00-0.11; I2 = 72%; P = 0.03); however, there was no difference in the incidence of intraoperative hypotension (RD, 0.01; 95% CI, -0.02 to 0.04; I2 = 3%; P = 0.45). It is important to note that all studies reported that intraoperative bradycardia was either transient in nature or reversible, when needed, with the administration of intravenous atropine. Conclusions: Dexmedetomidine has the ability to hasten the onset and prolong the duration of blockade when used as an adjuvant to local anesthesia for brachial plexus blockade. Considering an analgesic effect to be either decreased pain, a longer duration of analgesic block, or decreased opioid consumption, the addition of dexmedetomidine to local anesthetics for brachial plexus blockade was found to significantly improve analgesia in all 18 included studies. However, patients receiving dexmedetomidine should be continuouslymonitored for the potentially harmful but reversible adverse effect of intraoperative bradycardia. Level of Evidence: Therapeutic, level I.

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