Nicardipine controlled hypotension applied to perioperative blood loss in orthopedics: a meta-analysis

doi:10.3969/j.issn.2095-4344.3839

Abstract

Abstract: OBJECTIVE: The advantages and disadvantages of nicardipine are still controversial now. Some studies have reported that nicardipine used in orthopedic perioperative period reduces blood loss, but does not increase the risk of blood clots. However, these studies are small-sample trials, in the meantime, the results are still controversial. This paper discussed the effect of nicardipine on perioperative blood loss and blood transfusion in orthopedic department by meta-analysis.
METHODS: PubMed, Web of Science, ClinicalTrials, Cochrane library, CNKI, CBM, Wanfang and VIP databases were retrieved by computer for randomized controlled trials of nicardipine in reducing perioperative blood loss in orthopedics published from inception to February 15, 2020. The application of nicardipine in orthopedic perioperative bleeding was searched, and selected according to the inclusion criteria. The literature that could be extracted and analyzed by meta-analysis should be focused on (i.e., including the main outcome measure: intraoperative blood loss; or secondary outcome measures: incidence of adverse reactions, awake time, operation time, postoperative extubation time, postoperative hemoglobin concentration, intraoperative blood transfusion volume, and one or more items of hematocrit). After screening the literature, extracting data and assessing the risk of bias included in the study, the Stata12.0 software was used for meta-analysis.
RESULTS: Nine randomized controlled trials included 521 orthopedic surgery cases, with 275 cases in the nicardipine group and 246 patients in the control group. Results of meta-analysis showed that compared with other control groups included in this meta-analysis, (1) nicardipine reduced perioperative blood loss (SMD=-1.430, 95%CI: -2.570 to -0.290, P < 0.05); (2) nicardipine reduced the incidence of adverse reactions (OR=0.360, 95%CI: 0.130-1.020, P < 0.05), possibly prolonged patients’ awake time (SMD=0.936, 95%CI: 0.220-1.653, P < 0.001); (3) nicardipine may prolong the postoperative extubation time (SMD=1.889, 95%CI: 1.544-2.233, P < 0.001). (4) There was no significant effect on operation time, postoperative hemoglobin concentration, intraoperative blood transfusion volume and postoperative hematocrit (P > 0.05).
CONCLUSION: Nicardipine controlled hypotension is an effective method to reduce perioperative blood loss in orthopedic department. Nicardipine is safe for controlled hypotension in orthopedic perioperative period. However, it may prolong the awake time and extubation time of some patients. Therefore, clinicians should be more cautious when using this method. However, the above conclusions still need to be further confirmed by higher quality, large sample and multi-center randomized controlled trials.

Key words: bone, perioperative, nicardipine, orthopedics, hypotension, blood transfusion, intraoperative blood loss, randomized controlled trial, meta-analysis

CLC Number:

Zhong Yuanming, Fu Xiaopeng, Xu Wei, Zhao Qingrui, Huang Yong, Ye Weiquan. Nicardipine controlled hypotension applied to perioperative blood loss in orthopedics: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2930-2937.

Figures/Tables 12

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