Intravenous versus perineural dexmedetomidine in prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review

Authors

  • Yan Feng Laboratory of Anaesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
  • Pan Chang Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, China
  • Xiao-Bo Chen Department of general surgery, The First People’s Hospital of Shuangliu District Chengdu; West China (airport) Hospital, Sichuan University Chengdu 610041, Sichuan, China
  • Xiao-Lin Yang Department of Anesthesiology, North Sichuan Medical College, Nanchong 637000, Sichuan, China
  • Yu-Jun Zhang Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, Chengdu 610041, Sichuan, China
  • Wen-Sheng Zhang Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China

DOI:

https://doi.org/10.31636/pmjua.v6i2.2

Keywords:

local anesthesia, dexmedetomidine, adjunct drug, perineural, intravenous, analgesia, nerve block, adverse event

Abstract

Background and Objective. It is unclear whether perineural administration offers advantages when compared to intravenous dexmedetomidine in local anesthesia. To compare the efficacy of perineural versus intravenous dexmedetomidine as local anesthetic adjuvant, we conducted the meta analysis and systematic review.

Materials and Methods. Two researchers searched MEDLINE, OVID, PubMed, Embase, Cochrane Central, Web of Science and Wanfang data for randomized controlled trials comparing the effect of intravenous versus perineural dexmedetomidine as local anesthetic adjuvant without any language restrictions.

Results. We identified 14 randomized controlled trials (801 patients). The results revealed that the duration of analgesia (SMD: -1.76, 95 % CI, [-2.7, -0.83] P = 0.000, I2 = 96 %), the duration of sensory block (SMD:- 3.99, 95 % CI, [-5.88, -2.0], P = 0.000, I2 = 97.6 %), the duration of motor block (SMD: -1.6, 95 % CI, [-2.78, -0.41] P = 0.008, I 2 = 95.5 %) were significantly longer in the perineural group, when compared to systematic dexmedetomidine. The onset time of sensory block (SMD: 1.55, 95 % CI, [0.16, 2.94] P = 0.028, I2 = 96.7 %) and the onset time of motor block (SMD: 0.84, 95 % CI, [0.17, 1.5] P = 0.013, I2 = 88.3 %) were shorter in perineural group compared to intrave nous dexmedetomidine. Meanwhile, analgesic consumption in 24 hours (SMD: 0.37, 95 % CI, [0.05, 0.69] P = 0.023, I 2 = 55.6 %) and the incidence of patients of Ramsay Sedation Scale > 3 (RR: 3.8, 95 % CI, [1.45, 9.97] P = 0.000, I 2 = 26.9 %), hypotension (RR: 1.74, 95 % CI, [1.15, 2.65] P= 0.009, I2 = 32.7 %) and bradycardia (RR: 3.71, 95 % CI, [1.27, 10.86] P = 0.017, I2 = 0 %) were lower in perineural dexmedetomidine compared to the intravenous group.

Conclusions. Our meta-analysis generates the evidence that perineural dexmedetomidine is a superior adminstration for prolonging the duration of analgesia. Perineural dexmedetomidine also shows the advantages in duration of sensory block and the onset time of sensory and motor block, when compared to the intravenous administration. Simultaneously, dexmedetomidine as a local anesthetic adjuvant for perineural injection may be much safer than intravenous application because of the lower incidence of patients of Ramsay Sedation Scale > 3 and lower incidence of hypotension and bradycardia.

Downloads

Download data is not yet available.

References

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet [Internet]. Elsevier BV; 2006 May;367(9522):1618–25. Available from: https://doi.org/10.1016/s0140-6736(06)68700-x

Ilfeld BM. Continuous Peripheral Nerve Blocks. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2011 Oct;113(4):904–25. Available from: https://doi.org/10.1213/ane.0b013e3182285e01

Buckenmaier CC, Bleckner LL. Anaesthetic Agents for Advanced Regional Anaesthesia. Drugs [Internet]. Springer Science and Business Media LLC; 2005;65(6):745–59. Available from: https://doi.org/10.2165/00003495-200565060-00003

Song J-H, Shim HY, Lee TJ, Jung J-K, Cha Y-D, Lee DI, et al. Comparison of dexmedetomidine and epinephrine as an adjuvant to 1% mepivacaine in brachial plexus block. Korean Journal of Anesthesiology [Internet]. The Korean Society of Anesthesiologists; 2014;66(4):283. Available from: https://doi.org/10.4097/kjae.2014.66.4.283

Desai N, Kirkham KR, Albrecht E. Local anaesthetic adjuncts for peripheral regional anaesthesia: a narrative review. Anaesthesia [Internet]. Wiley; 2021 Jan;76(S1):100–9. Available from: https://doi.org/10.1111/anae.15245

Wang K, Wu M, Xu J, Wu C, Zhang B, Wang G, et al. Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. British Journal of Anaesthesia [Internet]. Elsevier BV; 2019 Dec;123(6):777–94. Available from: https://doi.org/10.1016/j.bja.2019.07.027

Charchaflieh J. Faculty Opinions recommendation of Low-dose Dexmedetomidine Improves Sleep Quality Pattern in Elderly Patients after Noncardiac Surgery in the Intensive Care Unit: A Pilot Randomized Controlled Trial. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature [Internet]. Faculty Opinions Ltd; 2016 Nov 14; Available from: https://doi.org/10.3410/f.726694276.793525347

Abdallah FW, Abrishami A, Brull R. The Facilitatory Effects of Intravenous Dexmedetomidine on the Duration of Spinal Anesthesia. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2013 Jul;117(1):271–8. Available from: https://doi.org/10.1213/ane.0b013e318290c566

Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. British Journal of Anaesthesia [Internet]. Elsevier BV; 2017 Feb;118(2):167–81. Available from: https://doi.org/10.1093/bja/aew411

Mane M, Lomate P. Efficacy of multimodal analgesia with perineural buprenorphine or dexmedetomidine for surgeries performed under ultrasound-guided infraclavicular brachial plexus block. Journal of Anaesthesiology Clinical Pharmacology [Internet]. Medknow; 2020;36(1):66. Available from: https://doi.org/10.4103/joacp.joacp_30_18

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine [Internet]. Public Library of Science (PLoS); 2009 Jul 21;6(7):e1000097. Available from: https://doi.org/10.1371/journal.pmed.1000097

Furlan AD, Pennick V, Bombardier C, van Tulder M. 2009 Updated Method Guidelines for Systematic Reviews in the Cochrane Back Review Group. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 Aug;34(18):1929–41. Available from: https://doi.org/10.1097/brs.0b013e3181b1c99f

Wetterslev J, Thorlund K, Brok J, Gluud C. Estimating required information size by quantifying diversity in random-effects model meta-analyses. BMC Medical Research Methodology [Internet]. Springer Science and Business Media LLC; 2009 Dec;9(1). Available from: https://doi.org/10.1186/1471-2288-9-86

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine [Internet]. Wiley; 2002;21(11):1539–58. Available from: https://doi.org/10.1002/sim.1186

Marhofer D, Kettner SC, Marhofer P, Pils S, Weber M, Zeitlinger M. Dexmedetomidine as an Adjuvant to Ropivacaine Prolongs Peripheral Nerve Block. Survey of Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2013 Oct;57(5):255–6. Available from: https://doi.org/10.1097/01.sa.0000433205.09568.42

Kathuria S, Gupta S, Dhawan I. Dexmedetomidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block. Saudi Journal of Anaesthesia [Internet]. Medknow; 2015;9(2):148. Available from: https://doi.org/10.4103/1658-354x.152841

Abdallah FW, Dwyer T, Chan VWS, Niazi AU, Ogilvie-Harris DJ, Oldfield S, et al. IV and Perineural Dexmedetomidine Similarly Prolong the Duration of Analgesia after Interscalene Brachial Plexus Block. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 Mar 1;124(3):683–95. Available from: https://doi.org/10.1097/aln.0000000000000983

Madhyastha K, K ST. A prospective, randomized, double blinded, controlled study to evaluate the efficacy of dexmedetomidine 50µg and dexamethasone 8mg as an adjuvant to ropivacaine 0.5% for supraclavicular brachial plexus block in elective upper limb surgeries. International journal of scientific research [Internet]. World Wide Journals; 2020 Nov 1;63–5. Available from: https://doi.org/10.36106/ijsr/3220448

Shashikala TK, Madhyastha K. A prospective randomized double blinded study to evaluate the efficacy of dexmedetomidine 50 μg intravenously and perineurally as an adjunct to 0.5% ropivacaine for supraclavicular brachial plexus block. Anaesthesia, Pain & Intensive Care. 2017:413-9.

Panneerselvam S, Sivakumar R, Cherian A, Rudingwa P, Menon J. Perineural vs. intravenous dexmedetomidine as an adjunct to bupivacaine in ultrasound guided fascia iliaca compartment block for femur surgeries: A randomised control trial. Indian Journal of Anaesthesia [Internet]. Medknow; 2018;62(11):851. Available from: https://doi.org/10.4103/ija.ija_397_18

Khan F, Singh VP. A comparative study of intravenous versus perineural administration of dexmedetomidine in supraclavicular brachial plexus block using 0.75% ropivacaine by ultrasound guided technique in upper limb surgeries. International Journal of Research in Medical Sciences [Internet]. Medip Academy; 2018 Jun 25;6(7):2407. Available from: https://doi.org/10.18203/2320-6012.ijrms20182826

Andersen JH, Jaeger P, Grevstad U, Estrup S, Geisler A, Vilhelmsen F, et al. Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block. Regional Anesthesia & Pain Medicine [Internet]. BMJ; 2019 Jan 23;44(3):333–40. Available from: https://doi.org/10.1136/rapm-2018-100089

Thapa D, Ahuja V, Pandey K, Gombar S, Gupta R. Evaluation of analgesic efficacy of dexmedetomidine as adjuvant with ropivacaine in ultrasound-guided adductor canal block in patients following anterior cruciate ligament reconstruction surgeries. British Journal of Pain [Internet]. SAGE Publications; 2018 Aug 30;13(2):91–8. Available from: https://doi.org/10.1177/2049463718796865

Zhang Panpan, Liu Shijiang, Zhu Jingming, Rao Zhuqing, Liu Cunming. Effect of different administration routes of dexmedetomidine in intercostal nerve block after thoracoscopic lobectomy. J Clin Anesthesiol. 2019; 35(5): 428-31. https://doi.org/10.12089/jca.2019.05.003

Archana N, Somsunder R, Shivkumar G, Krishna K. Comparing efficacy of perineural dexmedetomidine with intravenous dexmedetomidine as adjuvant to levobupivacaine in supraclavicular brachial plexus block. Anesthesia: Essays and Researches [Internet]. Medknow; 2019;13(3):441. Available from: https://doi.org/10.4103/aer.aer_105_19

Ahuja V, Thapa D, Chander A, Gombar S, Gupta R, Gupta S. Role of dexmedetomidine as adjuvant in postoperative sciatic popliteal and adductor canal analgesia in trauma patients: a randomized controlled trial. The Korean Journal of Pain [Internet]. Korean Pain Society; 2020 Apr 1;33(2):166–75. Available from: https://doi.org/10.3344/kjp.2020.33.2.166

Samar P, Dhawale TA, Pandya S. Comparative Study of Intravenous Dexmedetomidine Sedation With Perineural Dexmedetomidine on Supraclavicular Approach Brachial Plexus Block in Upper Limb Orthopaedic Surgery. Cureus [Internet]. Cureus, Inc.; 2020 Oct 2; Available from: https://doi.org/10.7759/cureus.10768

Yao F, Xu S, Zhang W, Xiong H, Han J, Zhu A. Impacts of different administration modes of dexmedetomidine with 0.5% ropivacaine on intercostal nerve block. Annals of Palliative Medicine [Internet]. AME Publishing Company; 2020 Mar;9(2):447–50. Available from: https://doi.org/10.21037/apm.2020.03.25

Lai Yuan,Zhang Jin,Li Kai. Influence on nerve block anesthesia effect and safety of dexmedetomidine using different methods of administration in elderly patients undergoing untensioned repair of inguinal hernia[J]. Adverse Drug Reactions Journal, 2020, 22(5): 283-288.

Gerlach AT, Murphy CV, Dasta JF. An Updated Focused Review of Dexmedetomidine in Adults. Annals of Pharmacotherapy [Internet]. SAGE Publications; 2009 Nov 25;43(12):2064–74. Available from: https://doi.org/10.1345/aph.1m310

Song AH, Kucyi A, Napadow V, Brown EN, Loggia ML, Akeju O. Pharmacological Modulation of Noradrenergic Arousal Circuitry Disrupts Functional Connectivity of the Locus Ceruleus in Humans. The Journal of Neuroscience [Internet]. Society for Neuroscience; 2017 Jun 16;37(29):6938–45. Available from: https://doi.org/10.1523/jneurosci.0446-17.2017

Brummett CM, Norat MA, Palmisano JM, Lydic R. Perineural Administration of Dexmedetomidine in Combination with Bupivacaine Enhances Sensory and Motor Blockade in Sciatic Nerve Block without Inducing Neurotoxicity in Rat. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Sep 1;109(3):502–11. Available from: https://doi.org/10.1097/aln.0b013e318182c26b

Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2011 Oct 1;115(4):836–43. Available from: https://doi.org/10.1097/aln.0b013e318221fcc9

Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. British Journal of Anaesthesia [Internet]. Elsevier BV; 2017 Feb;118(2):167–81. Available from: https://doi.org/10.1093/bja/aew411

Herman J, Urits I, Eskander J, Kaye A, Viswanath O. Adductor Canal Block Duration of Analgesia Successfully Prolonged With Perineural Dexmedetomidine and Dexamethasone in Addition to IPACK Block for Total Knee Arthroplasty. Cureus [Internet]. Cureus, Inc.; 2020 Sep 21; Available from: https://doi.org/10.7759/cureus.10566

Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clinical Pharmacokinetics [Internet]. Springer Science and Business Media LLC; 2017 Jan 19;56(8):893–913. Available from: https://doi.org/10.1007/s40262-017-0507-7

Wang C, Zhang Z, Ma W, Liu R, Li Q, Li Y. Perineural Dexmedetomidine Reduces the Median Effective Concentration of Ropivacaine for Adductor Canal Block. Medical Science Monitor [Internet]. International Scientific Information, Inc.; 2021 Jan 18;27. Available from: https://doi.org/10.12659/msm.929857

Rettig HC, Lerou JGC, Gielen MJM, Boersma E, Burm AGL. The pharmacokinetics of ropivacaine after four different techniques of brachial plexus blockade. Anaesthesia [Internet]. Wiley; 2007 Oct;62(10):1008–14. Available from: https://doi.org/10.1111/j.1365-2044.2007.05197.x

Stundner O, Meissnitzer M, Brummett CM, Moser S, Forstner R, Koköfer A, et al. Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trial † †Preliminary results of this study were presented as an abstract during the annual conference of the American Society of Regional Anesthesia (ASRA) in Las Vegas, NV, USA on May 15–16, 2015. British Journal of Anaesthesia [Internet]. Elsevier BV; 2016 Mar;116(3):405–12. Available from: https://doi.org/10.1093/bja/aev550

Intravenous versus perineural dexmedetomidine in  prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review

Downloads

Published

2021-08-28

How to Cite

1.
Feng Y, Chang P, Chen X-B, Yang X-L, Zhang Y-J, Zhang W-S. Intravenous versus perineural dexmedetomidine in prolongation of analgesia with regional anesthesia: a meta-analysis and systematic review. PMJUA [Internet]. 2021 Aug. 28 [cited 2021 Sep. 24];6(2):10-28. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/255

Issue

Section

Original article