Departments of Anesthesiology.
Neurosurgery, the First Affiliated Hospital.
J Neurosurg Anesthesiol. 2018 Apr;30(2):146-155. doi: 10.1097/ANA.0000000000000403.
Dexmedetomidine (DEX) has been administered to patients during neurosurgery. Some studies have found that DEX could reduce perioperative opioid consumption and postoperative pain intensity. However, no firm conclusions have been reached. The purpose of this meta-analysis was to assess the efficacy of DEX for managing pain in neurosurgical patients.
A comprehensive literature review was conducted to identify randomized controlled trials (RCTs) focusing on the effects of DEX on perioperative opioid consumption and postoperative pain intensity in patients undergoing neurosurgery. PubMed, the Web of science, the Cochrane Library, and Scopus were searched. The resulting data were combined to calculate the pooled mean differences (MDs), standard MDs or odds ratios (ORs), and 95% confidence intervals (CIs), as appropriate. Heterogeneity and potential publication bias were assessed. Furthermore, a trial sequential analysis was performed to improve the precision of our findings.
A total of 11 published RCTs involving 674 patients undergoing neurosurgery (335 patients, 339 controls) were included in this meta-analysis. There were significant differences in postanesthesia care unit (PACU) visual analog scale scores between the groups (MD=-1.54, 95% CI, -2.33 to 0.75, I=87%, P=0.0001). In addition, there were significant differences in PACU opioid requirements between the treatment and control groups (standard MD=-0.88, 95% CI, -1.74 to 0.02, I=91%, P=0.05). Furthermore, intraoperative opioid consumption was significantly reduced in the treatment group (MD=-127.75, 95% CI, -208.62 to 46.89, I=98%, P=0.002).
DEX could reduce perioperative and PACU opioid consumption as well as postoperative pain intensity.
右美托咪定（DEX）已在神经外科手术中用于患者。一些研究发现 DEX 可以减少围手术期阿片类药物的消耗和术后疼痛强度。然而，没有得出明确的结论。本荟萃分析的目的是评估 DEX 管理神经外科患者疼痛的疗效。
进行了全面的文献综述，以确定专注于 DEX 对接受神经外科手术的患者围手术期阿片类药物消耗和术后疼痛强度影响的随机对照试验（RCT）。检索了 PubMed、Web of Science、Cochrane 图书馆和 Scopus。将所得数据合并以计算合并均数差（MD）、标准 MD 或比值比（OR）和 95%置信区间（CI），视情况而定。评估了异质性和潜在的发表偏倚。此外，进行了试验序贯分析以提高我们发现的准确性。
本荟萃分析共纳入 11 项已发表的 RCT，涉及 674 例接受神经外科手术的患者（335 例患者，339 例对照）。两组患者在麻醉后护理病房（PACU）视觉模拟评分上存在显著差异（MD=-1.54，95%CI，-2.33 至 0.75，I=87%，P=0.0001）。此外，治疗组和对照组在 PACU 阿片类药物需求方面存在显著差异（标准 MD=-0.88，95%CI，-1.74 至 0.02，I=91%，P=0.05）。此外，治疗组术中阿片类药物消耗明显减少（MD=-127.75，95%CI，-208.62 至 46.89，I=98%，P=0.002）。
DEX 可减少围手术期和 PACU 阿片类药物的消耗以及术后疼痛强度。
