Intrathecal dexmedetomidine is tied to longer analgesia, reduced postop pain

  • Paramasivan A & al.
  • Eur J Pain
  • 25 abr. 2020

  • de Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Adding intrathecal dexmedetomidine (DEX) to local anesthetic (LA) agents significantly prolongs postoperative analgesia duration compared with placebo, with less pain at 24 hours and less shivering.

Why this matters

  • Adding intrathecal adjuncts to LA can extend analgesia without increases in LA, which reduces risk for poor LA-related outcomes such as cardiorespiratory instability and systemic toxicity.

Study design

  • Meta-analysis of 24 randomized controlled trials (RCTs) with 1460 patients who underwent elective surgery with LA plus intrathecal DEX (n=769) or placebo (n=691).
  • Funding: None.

Key results

  • Median postoperative analgesic duration was significantly longer with DEX vs placebo:
    • 363.6 vs 204.0 minutes.
    • Mean difference: 191.3 (95% CI, 168.8-213.8) minutes.
  • Pain scores were significantly lower at 24 hours after surgery with DEX vs placebo (−1 point out of a 10-point scale; 95% CI, −1.9 to −0.20 points; P=.02), but not at 6 and 12 hours after surgery.
  • Shivering was significantly less likely with DEX (5% vs 9%; pooled relative risk, 0.58; P=.04), but rates of other adverse events were similar between groups.

Limitations

  • Individual RCT sample sizes were small.