- 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.
- 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.
- 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.
- Individual RCT sample sizes were small.