Analgesic effects of dexmedetomidine combined with shoulder nerve blocks before arthroscopy: a meta-analysis of randomized-controlled trials.

PURPOSE

Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.

METHODS

A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.

RESULTS

Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.

CONCLUSIONS

This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.