title: Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis.
abstract: BACKGROUND
  Neuraxial application of dexmedetomidine (DEX) as adjuvant analgesic has been invetigated in some randomized controlled trials (RCTs) but not been approved because of the inconsistency of efficacy and safety in these RCTs. We performed this meta-analysis to access the efficacy and safety of neuraxial DEX as local anaesthetic (LA) adjuvant.
  
  
  METHODS
  We searched PubMed, PsycINFO, Scopus, EMBASE, and CENTRAL databases from inception to June 2013 for RCTs that investigated the analgesia efficacy and safety for neuraxial application DEX as LA adjuvant. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMDs) or odds ratio (OR) with suitable effect model. The primary outcomes were postoperative pain intensity and analgesic duration, bradycardia and hypotension.
  
  
  RESULTS
  Sixteen RCTs involving 1092 participants were included. Neuraxial DEX significantly decreased postoperative pain intensity (SMD, -1.29; 95% confidence interval (CI), -1.70 to -0.89; P<0.00001), prolonged analgesic duration (WMD, 6.93 hours; 95% CI, 5.23 to 8.62; P<0.00001) and increased the risk of bradycardia (OR, 2.68; 95% CI, 1.18 to 6.10; P = 0.02). No evidence showed that neuraxial DEX increased the risk of other adverse events, such as hypotension (OR, 1.54; 95% CI, 0.83 to 2.85; P = 0.17). Additionally, neuraxial DEX was associated with beneficial alterations in postoperative sedation scores and number of analgesic requirements, sensory and motor block characteristics, and intro-operative hemodynamics.
  
  
  CONCLUSIONS
  Neuraxial DEX is a favorable LA adjuvant with better and longer analgesia. The greatest concern is bradycardia. Further large sample trials with strict design and focusing on long-term outcomes are needed.
authors.affiliation: Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China; Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China.
authors.forename: Huang-Hui
authors.initials: HH
authors.lastname: Wu
authors.affiliation: Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; Department of Burn and Cutaneous Surgery, Xi'jing Hospital, Fourth Military Medical University, Xi'an, PR China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Wang
authors.affiliation: Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; Department of Neurosurgery, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China.
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Jin
authors.affiliation: Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; Department of Diagnostic Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, PR China.
authors.forename: Guang-Bin
authors.initials: GB
authors.lastname: Cui
authors.affiliation: Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China; China Pharmaceutical University, Nanjing, PR China.
authors.forename: Ke-Cheng
authors.initials: KC
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, PR China.
authors.forename: Guo-Zhong
authors.initials: GZ
authors.lastname: Chen
authors.affiliation: Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Dong
authors.affiliation: Unit for Evidence Based Medicine, Department of Anatomy, Histology and Embryology & K.K. Leung Brain Research Centre, Preclinical School of Medicine, Fourth Military Medical University, Xi'an, PR China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
mesh_terms: D000698:Analgesia / Q000379:methods; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000758:Anesthesia / Q000379:methods; D000779:Anesthetics, Local / Q000627:therapeutic use; D001919:Bradycardia / Q000139:chemically induced; D017024:Chemotherapy, Adjuvant; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D059408:Pain Management; D010149:Postoperative Pain / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
chemical_list: D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D020927:Dexmedetomidine