Waloejo Christrijogo Soemartono, Musalim Dian Anggraini Permatasari, Budi David Setyo, Pratama Nando Reza, Sulistiawan Soni Sunarso, Wungu Citrawati Dyah Kencono
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia.
Faculty of Medicine, Universitas Airlangga, Surabaya 60115, Indonesia.
J Clin Med. 2024 May 28;13(11):3166. doi: 10.3390/jcm13113166.
: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. : Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. : Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = -1.99 [95% CI -3.01 to -0.98], = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = -1.34 [95% CI -2.29 to -0.40], = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. : Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile.
我们对右美托咪定作为癌症手术中神经阻滞辅助药物的理解目前的特点是缺乏令人信服的证据，使用其潜在益处是否超过风险仍不清楚。本研究的目的是评估右美托咪定作为癌症手术中神经阻滞辅助药物的益处和安全性。：截至2024年5月17日，在MEDLINE、ScienceDirect、Cochrane图书馆、Springer、medRxiv和Scopus中进行了系统检索。对二元结局的风险比（RR）和连续结局的标准化均值差（SMD）进行了量化。：共纳入20项研究。在乳腺癌手术中，使用右美托咪定可减少24小时总吗啡消耗量（SMD=-1.99[95%CI-3.01至-0.98]，P=0.0001，I²=91%，随机效应），并延长吗啡解救镇痛的需求时间（SMD=2.98[95%CI0.01至5.95]，P=0.05，I²=98%，随机效应）。在腹部癌症手术中，右美托咪定组的舒芬太尼总消耗量较低（SMD=-1.34[95%CI-2.29至-0.40]，P=0.005，I²=84%，随机效应）。右美托咪定降低了视觉模拟评分（VAS）并减少了术后恶心和呕吐（PONV）。使用右美托咪定的研究均未报告严重不良事件。：在癌症手术中使用右美托咪定作为神经阻滞辅助药物可降低VAS疼痛评分并延长区域麻醉持续时间，这将导致总阿片类药物消耗量减少，并可能减少PONV事件。此外，未报告严重不良事件表明其安全性良好。
