Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India.
Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
Surg Obes Relat Dis. 2017 Aug;13(8):1434-1446. doi: 10.1016/j.soard.2017.02.025. Epub 2017 Mar 10.
Opioid-sparing analgesia for bariatric surgery in morbidly obese can potentially prevent catastrophic airway complications. Our meta-analysis attempts to consolidate the evidence on dexmedetomidine evaluating its analgesic and safety profile.
Trails comparing perioperative dexmedetomidine infusion to conventional analgesic regimens for bariatric surgery were searched. Comparisons were made for 24-hour and postanesthesia care unit (PACU) morphine consumed, PACU pain scores, postoperative nausea and vomiting pain scores, and heartrate. Meta-regression was performed for length of stay to evaluate various analgesic control subgroups.
Six trials were included in the final analysis. Dexmedetomidine infusion (reported in 5 intraoperative subgroups and 2 postoperative subgroups) decreased 24-hour morphine by 18.13±6.11 mg (random effects: P<.001, I = 95.48%). Despite the small number of included studies, the sample size for avoiding a false positive result was adequate as the trial sequential analysis found the present sample size (362) to be well past the required "sample size" (n = 312) for 85% power. Meta-regression for infusion dose on morphine consumption difference found a predictability of 49% (coefficient = 39.93, random-effects, Tau = 396.08), and predictability of the model improved to 68% on inclusion of time of initiation of infusion. The dexmedetomidine group had lower PACU morphine consumption (by 6.91±1.19, I = 34.37%), lower pain scores (scale of 0-10±2.27, I = 88.14%), lower postoperative nausea and vomiting incidence (odds ratio =±0.26, I = 0%), and lower heart rate (73.25 versus. 83.50) (mean difference =±10.15 I = 94.04%). No adverse events were reported across trials.
Perioperative dexmedetomidine infusion in obese patients undergoing bariatric surgery is a promising and safe alternative. Both intraoperative or postoperative infusions lead to significant opioid sparing in early and extend postoperative recovery phase. Morbidly obese patients receiving perioperative dexmedetomidine infusions have overall better pain control and lower incidence of postoperative nausea-vomiting. All the aforementioned merits come with a stable hemodynamic profile and without any reported major adverse events.
肥胖患者行减重手术时使用阿片类药物镇痛可能会预防灾难性气道并发症。本荟萃分析旨在整合右美托咪定用于评估其镇痛和安全性的证据。
检索了比较围手术期右美托咪定输注与常规镇痛方案用于减重手术的试验。比较了 24 小时和麻醉后恢复室（PACU）吗啡消耗量、PACU 疼痛评分、术后恶心和呕吐疼痛评分以及心率。进行了荟萃回归分析以评估各种镇痛控制亚组的住院时间。
最终分析纳入了 6 项试验。右美托咪定输注（在 5 个术中亚组和 2 个术后亚组中报告）可使 24 小时吗啡消耗量减少 18.13±6.11mg（随机效应：P<.001，I = 95.48%）。尽管纳入的研究数量较少，但避免假阳性结果的样本量足够大，因为试验序贯分析发现，目前的样本量（362）远超过 85%效能所需的“样本量”（n = 312）。荟萃回归分析显示，输注剂量对吗啡消耗差异的预测能力为 49%（系数=39.93，随机效应，Tau = 396.08），纳入输注开始时间后，模型的预测能力提高到 68%。右美托咪定组 PACU 吗啡消耗量较低（减少 6.91±1.19，I = 34.37%），疼痛评分较低（0-10 分±2.27，I = 88.14%），术后恶心和呕吐发生率较低（比值比=±0.26，I = 0%），心率较低（73.25 与 83.50）（均数差=±10.15，I = 94.04%）。试验中未报告任何不良事件。
肥胖患者行减重手术时，围手术期右美托咪定输注是一种有前途且安全的替代方案。术中或术后输注均可在早期和延长的术后恢复阶段显著减少阿片类药物的使用。接受围手术期右美托咪定输注的肥胖患者具有更好的整体疼痛控制和更低的术后恶心呕吐发生率。所有这些优点均具有稳定的血液动力学特征，并且没有报告任何重大不良事件。
