title: Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Brachial plexus block (BPB) for upper extremity surgery provides superior analgesia, but this advantage is limited by the pharmacological duration of local anesthetics. Dexmedetomidine (DEX) as a local anesthetics adjuvant for BPB has been utilized to prolong the duration of the nerve block in some randomized controlled trials (RCTs) but is far from unanimous in the efficacy and safety of the perineural route. Hence, an updated meta-analysis was conducted to assess the efficacy and safety of DEX as local anesthetic adjuvants on BPB.
  
  
  METHODS
  A search in electronic databases was conducted to collect the RCTs that investigated the impact of adding DEX to local anesthetics for BPB. Sensory block duration, motor block duration, onset time of sensory and motor block, time to first analgesic request, the common adverse effects were analyzed.
  
  
  RESULTS
  Eighteen trails (1014 patients) were included with 515 patients receiving perineural DEX. The addition of DEX prolonged the duration of sensory block (WMD 257 minutes, 95%CI 191.79-322.24, P < 0.001), motor block (WMD 242 minutes, 95%CI 174.94-309.34, P < 0.001), and analgesia (WMD 26 6 minutes, 95%CI 190.75-342.81, P < 0.001). Perineural DEX also increased the risk of bradycardia (OR=8.25, 95%CI 3.95-17.24, P < 0.001), hypotension (OR = 5.62, 95%CI 1.52-20.79, P < 0.01), and somnolence (OR = 19.67, 95%CI 3.94-98.09, P < 0.001). There was a lack of evidence that perineural DEX increased the risk of other adverse events.
  
  
  CONCLUSIONS
  DEX is a potential anesthetic adjuvant that can facilitate better anesthesia and analgesia when administered in BPB. However, it also increased the risk of bradycardia, hypotension, and somnolence. Further research should focus on the efficacy and safety of the preneural administration of DEX.
authors.affiliation: Department of Anaesthesiology, Maternal and Children Hospital of Lishui City, Lishui Department of Anaesthesiology, Taizhou First People's Hospital and Huangyan Hospital of Wenzhou Medical University, Taizhou, China.
authors.forename: Yongmei
authors.initials: Y
authors.lastname: Ping
authors.forename: Qigang
authors.initials: Q
authors.lastname: Ye
authors.forename: Wenwei
authors.initials: W
authors.lastname: Wang
authors.forename: Pingke
authors.initials: P
authors.lastname: Ye
authors.forename: Zhibin
authors.initials: Z
authors.lastname: You
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D065527:Brachial Plexus Block / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D034941:Upper Extremity / Q000601:surgery
chemical_list: D000759:Adjuvants, Anesthesia; D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D020927:Dexmedetomidine