Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (12): 1951-1958.doi: 10.3969/j.issn.2095-4344.3780

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Dexmedetomidine combined with local anesthetic for brachial plexus block: a systematic review and meta-analysis

Wang Shao1, Yuan Dajiang2, Li Yanyan1, Li Xiaoya1   

  1. 1Department of Anesthesiology, Shanxi Medical University, Taiyuan  030000, Shanxi Province, China; 2Department of Critical Medicine, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • Received:2020-05-09 Revised:2020-05-12 Accepted:2020-05-27 Online:2021-04-28 Published:2020-12-26
  • Contact: Yuan Dajiang, MD, Chief physician, Department of Critical Medicine, Second Hospital of Shanxi Medical University, Taiyuan 030000, Shanxi Province, China
  • About author:Wang Shao, Master candidate, Department of Anesthesiology, Shanxi Medical University, Taiyuan 030000, Shanxi Province, China

Abstract: OBJECTIVE: The current research sample on the effect of dexmedetomidine in brachial plexus block is small and the results are inconsistent. Meta-analysis was used to evaluate the effect of dexmedetomidine combined with local anesthetics on brachial plexus block.
METHODS: In PubMed, Embase, Cochrane Library, CNKI, Wanfang Medical Network, and VIP database, the authors searched for related literature published from inception to December 2019 based on keywords such as dexmedetomidine, and brachial plexus block. The type of study included was clinical randomized controlled trials. The subjects were patients over 18 years old who received brachial plexus blockade. The intervention was dexmedetomidine combined with local anesthetics. Two researchers independently screened the literature. The Cochrane systematic review manual was used for literature quality evaluation, and Revman5.3 software was used for meta-analysis. The main outcome measures included the duration of analgesia and the duration of exercise block, and the secondary outcome measure was adverse events. Weighted mean difference and relative risk were used as the combined effects.
RESULTS:  (1) A total of 24 articles were included, with 1 612 samples. One article did not mention randomness, 11 did not mention allocation concealment, and 6 did not mention blind method. (2) Both perineural (WMD=182.91, 95%CI:129.85-235.96, P < 0.001) and intravenous dexmedetomidine (WMD=180.47, 95%CI:83.01-277.93, P=0.000 3) could effectively prolong analgesic duration. Perineural application could also extend the duration of motor block (WMD=147.57, 95%CI:120.81-174.33, P < 0.001). (3) Compared with the intravenous group, the perineural group had an advantage in extending the duration of analgesia (WMD=69.24, 95%CI:24.92-113.56, P=0.002) and the duration of motor block (WMD=74.35, 95%CI:47.68-101.01, P < 0.001). (4) After applying dexmedetomidine, the most common adverse event was bradycardia (RR=5.08, 95%CI:3.25-7.93, P < 0.001). 
CONCLUSION: Dexmedetomidine combined with local anesthetic can significantly prolong the duration of brachial plexus block, but simultaneously increase the incidence of bradycardia. In terms of duration of analgesia and duration of exercise block, peri-brachial plexus administration is superior to intravenous administration. However, this article also has the shortcomings of high heterogeneity and low quality of the included literature. Therefore, more large-scale multicenter high-quality randomized controlled trials are still needed for further verification in the future.

Key words: anesthesia, brachial plexus, analgesia, block, intravenous, administration route, meta-analysis, systematic review

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