右美托咪定作为局麻药辅助用于竖脊肌平面阻滞的效果和安全性：一项随机对照试验的系统评价和荟萃分析。
The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Anesthesiology & Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China.
706A Ward, Huzhou Central Hospital (The Affiliated Huzhou Hospital, Zhejiang University School of Medicine; The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University; Affiliated Central Hospital Huzhou University), No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313003, Zhejiang Province, People's Republic of China.
出版信息
BMC Anesthesiol. 2023 Feb 27;23(1):61. doi: 10.1186/s12871-023-02019-x.
BACKGROUND
Dexmedetomidine (DEX) has been thought to be an effective adjuvant to local anesthetics (LAs) in erector spinae plane block (ESPB), however, this method of use is not recorded in the drug instructions. Hence, our meta-analysis will evaluate its efficacy and safety for the first time.
METHODS
A systematic search of published articles was conducted in the PubMed, Embase, Web of science, and Cochrane Library databases up to July 17, 2022, using specific keywords related to our aims. The time first to request rescue analgesia, number of patient controlled intravenous analgesia (PCIA) presses, rate of rescue analgesia use, postoperative nausea and vomiting (PONV), arrhythmia, and hypotension were calculated by using random-effect models. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42022345488).
RESULTS
Numerous electronic databases were searched and finally 8 studies with a total of 570 patients, 303 in the DEX arm, 267 in the control arm were included. As an adjuvant to LAs, DEX significantly increased the time to first request of rescue analgesia (mean difference [MD] = 8.40, 95% confidence interval [CI] = 4.70-12.10, P < 0.00001), reduced the number of PCIA presses (MD = -4.12, 95% CI = -7.79 to -0.45, P = 0.03) and the rate of rescue analgesia (odds ratio [OR] = 0.33, 95% CI = 0.17-0.65, P = 0.002). Moreover, the combination reduced the risk of PONV (OR = 0.57, 95% CI = 0.36-0.91, P = 0.02). In addition, there was no difference in the incidence of hypotension (OR = 1.01, 95% CI = 0.37-2.74, P = 0.99) and arrhythmia (OR = 0.76, 95% CI = 0.19-3.07, P = 0.70).
CONCLUSION
DEX can reduce analgesic requirements after various surgical procedures when used as an adjuvant to LAs for ESPB. Moreover, there was no significant difference between the two groups in terms of safety indicators (arrhythmia, hypotension).
背景
右美托咪定（DEX）被认为是竖脊肌平面阻滞（ESPB）中局部麻醉剂（LA）的有效辅助剂，但这种用法不在药物说明书中记录。因此，我们的荟萃分析将首次评估其疗效和安全性。
方法
我们在 PubMed、Embase、Web of science 和 Cochrane Library 数据库中进行了系统搜索，截至 2022 年 7 月 17 日，使用与我们目标相关的特定关键字。使用随机效应模型计算首次请求解救镇痛的时间、患者自控静脉镇痛（PCIA）按压次数、解救镇痛使用率、术后恶心呕吐（PONV）、心律失常和低血压的发生率。本系统评价和荟萃分析在 PROSPERO（注册号：CRD42022345488）中进行了注册。
结果
我们对大量电子数据库进行了搜索，最终纳入了 8 项研究，共 570 例患者，DEX 组 303 例，对照组 267 例。作为 LA 的辅助剂，DEX 显著增加了首次请求解救镇痛的时间（均数差[MD] = 8.40，95%置信区间[CI] = 4.70-12.10，P < 0.00001），减少了 PCIA 按压次数（MD = -4.12，95% CI = -7.79 至 -0.45，P = 0.03）和解救镇痛使用率（比值比[OR] = 0.33，95% CI = 0.17-0.65，P = 0.002）。此外，联合用药降低了 PONV 的风险（OR = 0.57，95% CI = 0.36-0.91，P = 0.02）。此外，低血压（OR = 1.01，95% CI = 0.37-2.74，P = 0.99）和心律失常（OR = 0.76，95% CI = 0.19-3.07，P = 0.70）的发生率在两组之间无差异。
结论
DEX 可作为 ESPB 中 LA 的辅助剂，减少各种手术术后的镇痛需求。此外，两组在安全性指标（心律失常、低血压）方面无显著差异。
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