• Paediatric anaesthesia · Dec 2014

    Review Meta Analysis

    Analgesic effect and adverse events of dexmedetomidine as additive for pediatric caudal anesthesia: a meta-analysis.

    • Yao Tong, Hao Ren, Xibing Ding, Shuqing Jin, Zhixia Chen, and Quan Li.
    • Department of Anesthesiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Anesthesiology, East Hospital, Tongji University School of Medicine, Shanghai, China.
    • Paediatr Anaesth. 2014 Dec 1;24(12):1224-30.

    BackgroundDexmedetomidine has become a popular additive for regional anesthesia. Aim of this meta-analysis was to assess the effect of this additive on the duration of postoperative analgesia and possible adverse events in pediatrics undergoing orchidopexy or lower abdominal surgery.MethodsThe literature databases of PubMed, Google Scholar, and Cochrane Library were searched for randomized, controlled trials (RCTs). Odds ratio (OR), weighted mean difference (WMD), and the corresponding 95% confidence intervals (CIs) were calculated using the RevMan software, version 5.2, for data synthesis and statistical analysis, which in accordance with the PRISMA statement.ResultsSix RCTs were selected for this meta-analysis, involving a total of 328 pediatric patients. There was a significant longer duration of caudal analgesia (time to first analgesic requirements) in patients receiving dexmedetomidine with CA compared with CA alone (WMD: -8.21 h; 95% CI: -11.40 to -5.02; P < 0.00001). Side effects in these two groups were comparable (OR: 1.02; 95% CI: 0.51-2.04; P = 0.95). Subgroup analysis indicated there was no significant difference in hemodynamic changes during operation (WMD: 1.78; 95% CI: -3.20 to 6.77; P = 0.48) and the emergence time (time from the end of surgery to opening the eyes on calling) after surgery (WMD: 0.47 min; 95% CI: -5.27 to 6.22; P = 0.87).ConclusionsDexmedetomidine as an additive to local anesthetic provides a significantly longer postoperative analgesia with comparable adverse effects and hemodynamic changes, when compared to local anesthetics alone. There were insufficient data of the effects of different concentrations of dexmedetomidine; further studies are required to explore this issue.© 2014 John Wiley & Sons Ltd.

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    Is the prolonged effect thought due to Dexmetetomidine's high protein binding?

    Pieter Peach  Pieter Peach
     
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