围手术期右美托咪定对骨科手术术后疼痛及神经认知功能的疗效：一项随机对照试验的系统评价和Meta分析以及试验序贯分析

Efficacy of perioperative dexmedetomidine in postoperative pain and neurocognitive functions in orthopedic surgery: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials.

作者信息

Zhang Xiang, Leng Yu, Yuan Xiurong, Yang Yaoxin, Zhou Cheng, Liu Hao

机构信息

Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Int J Surg. 2025 May 1;111(5):3525-3542. doi: 10.1097/JS9.0000000000002315.

INTRODUCTION

With an estimated 2.1 million hip and knee replacements performed annually in developed countries, orthopedic surgeries can result in complications such as postoperative pain and cognitive dysfunctions. Dexmedetomidine shows potential for reducing pain and opioid use and improving cognitive outcomes, but its efficacy in orthopedic settings needs further evaluation.

METHODS

A comprehensive literature search was performed across electronic databases (e.g., PubMed) up to 1 June 2024 to identify relevant randomized controlled trials (RCTs) investigating the use of dexmedetomidine for orthopedic surgeries. The primary outcomes included visual analog scale (VAS), opioid consumption, incidence of postoperative cognitive dysfunction (POCD), and postoperative delirium (POD). Meta-analysis was conducted using RevMan 5.3 and Stata 16.0, with statistical significance set at P < 0.05. Sensitivity analyses, along with trial sequential analysis (TSA), were used to evaluate the robustness of the findings.

RESULTS

The meta-analysis included 59 RCTs with 7713 participants and demonstrated that dexmedetomidine significantly reduced postoperative VAS score (mean difference [MD] -0.50, P = 0.0003) and opioid consumption (MD -11.91, P < 0.0001) and decreased the incidence of POCD (risk ratio [RR] 0.59, P = 0.006) and POD (RR 0.49, P < 0.0001). Dexmedetomidine also prolonged motor (MD: 1.70, P < 0.0001) and sensory block durations (MD: 1.80, P < 0.0001) and delayed the time to first rescue analgesics (MD: 1.51, P < 0.0001). TSA and sensitivity analysis confirmed the robustness and reliability of the results, whereas meta-regression revealed no significant effect of variables on primary outcomes.

CONCLUSION

Our study demonstrates that intravenous dexmedetomidine significantly improved postoperative pain and neurocognitive functions in orthopedic surgery patients.

引言

在发达国家，每年估计有210万例髋关节和膝关节置换手术，骨科手术可能会导致术后疼痛和认知功能障碍等并发症。右美托咪定显示出减轻疼痛、减少阿片类药物使用以及改善认知结局的潜力，但其在骨科手术中的疗效需要进一步评估。

方法

截至2024年6月1日，在电子数据库（如PubMed）中进行了全面的文献检索，以识别研究右美托咪定在骨科手术中应用的相关随机对照试验（RCT）。主要结局包括视觉模拟评分（VAS）、阿片类药物消耗量、术后认知功能障碍（POCD）发生率和术后谵妄（POD）发生率。使用RevMan 5.3和Stata 16.0进行荟萃分析，设定统计学显著性为P < 0.05。采用敏感性分析以及试验序贯分析（TSA）来评估研究结果的稳健性。

结果

荟萃分析纳入了59项RCT，共7713名参与者，结果表明右美托咪定显著降低了术后VAS评分（平均差值[MD] -0.50，P = 0.0003）和阿片类药物消耗量（MD -11.91，P < 0.0001），并降低了POCD发生率（风险比[RR] 0.59，P = 0.006）和POD发生率（RR 0.49，P < 0.0001）。右美托咪定还延长了运动阻滞（MD：1.70，P < 0.0001）和感觉阻滞持续时间（MD：1.80，P < 0.0001），并延迟了首次使用解救镇痛药的时间（MD：1.51，P < 0.0001）。TSA和敏感性分析证实了结果的稳健性和可靠性，而荟萃回归显示变量对主要结局无显著影响。