Department of Thoracic Surgery.
Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University.
Medicine (Baltimore). 2021 Apr 9;100(14):e25272. doi: 10.1097/MD.0000000000025272.
Ropivacaine is considered the most commonly used for epidural anesthesia. We compared the efficiency and safety of ropivacaine alone (R group) and ropivacaine combined with dexmedetomidine (RD group).
PubMed, the Cochrane Library, Google Scholar, Ovid Medline, the Web of Science, Scopus, Embase, and ScienceDirect were searched. We considered sensory and motor block, duration of anesthesia, time to rescue, hemodynamics, and adverse effects as the primary endpoints.
Eleven randomized controlled trials were included with 337 patients in the R group and 336 patients in the RD group. The RD group had a shorter time to onset of sensory (mean difference [MD]: 3.97 [1.90-6.04] minutes; P = .0002) and motor (MD: 2.43 [0.70-4.16] minutes; P = .006) block and a longer duration of anesthesia (MD: -164.17 [-294.43 to -33.91]; P = .01) than the R group. Comparison of the time to rescue between the groups showed no significant difference (MD: -119.01[-254.47-16.46] minutes; P = 0.09). The R group showed more stable hemodynamics than the RD group in heart rate and arterial pressure at 10 minutes. The R group had a lower incidence of bradycardia and a higher incidence of shivering than the RD group.
RD may be a more suitable choice for epidural anesthesia with better anesthetic outcomes than R alone. However, the safety of the combination must be carefully assessed.
罗哌卡因被认为是最常用于硬膜外麻醉的药物。我们比较了单独使用罗哌卡因（R 组）和罗哌卡因联合右美托咪定（RD 组）的效果和安全性。
我们检索了 PubMed、Cochrane 图书馆、Google Scholar、Ovid Medline、Web of Science、Scopus、Embase 和 ScienceDirect。我们将感觉和运动阻滞、麻醉持续时间、抢救时间、血液动力学和不良反应作为主要终点。
共纳入 11 项随机对照试验，R 组 337 例，RD 组 336 例。RD 组感觉阻滞（均数差值 [MD]：3.97 [1.90-6.04] 分钟；P = .0002）和运动阻滞（MD：2.43 [0.70-4.16] 分钟；P = .006）的起效时间更短，麻醉持续时间更长（MD：-164.17 [-294.43 至 -33.91]；P = .01）。两组间抢救时间的比较无显著差异（MD：-119.01 [-254.47-16.46] 分钟；P = 0.09）。与 RD 组相比，R 组在 10 分钟时心率和动脉压更稳定。R 组心动过缓的发生率较低，而 RD 组寒战的发生率较高。
与单独使用 R 相比，RD 可能是一种更适合硬膜外麻醉的选择，具有更好的麻醉效果。然而，必须仔细评估联合用药的安全性。
