NDLI: Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Vorobeichik, L. Brull, R. Abdallah, F. W.
Description	Country affiliation: Canada Author Affiliation: Vorobeichik L ( Department of Anaesthesia, University of Toronto, Toronto, Canada.); Brull R ( Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Toronto, Canada.); Abdallah FW ( Department of Anaesthesia, University of Toronto, Toronto, Canada.)
Abstract	BACKGROUND: Dexmedetomidine has been proposed as a perineural local anaesthetic (LA) adjunct to prolong peripheral nerve block duration; however, results from our previous meta-analysis in the setting of brachial plexus block (BPB) did not support its use. Many additional randomized trials have since been published. We thus conducted an updated meta-analysis. METHODS: Randomized trials investigating the addition of dexmedetomidine to LA compared with LA alone (Control) in BPB for upper extremity surgery were sought. Sensory and motor block duration, onset times, duration of analgesia, analgesic consumption, pain severity, patient satisfaction, and dexmedetomidine-related side-effects were analysed using random-effects modeling. We used ratio-of-means (lower confidence interval [point estimate]) for continuous outcomes. RESULTS: We identified 32 trials (2007 patients), and found that dexmedetomidine prolonged sensory block (at least 57%, P < 0.0001), motor block (at least 58%, P < 0.0001), and analgesia (at least 63%, P < 0.0001) duration. Dexmedetomidine expedited onset for both sensory (at least 40%, P < 0.0001) and motor (at least 39%, P < 0.0001) blocks. Dexmedetomidine also reduced postoperative oral morphine consumption by 10.2mg [-15.3, -5.2] (P < 0.0001), improved pain control, and enhanced satisfaction. In contrast, dexmedetomidine increased odds of bradycardia (3.3 [0.8, 13.5](P = 0.0002)), and hypotension (5.4 [2.7, 11.0] (P < 0.0001)). A 50-60µg dexmedetomidine dose maximized sensory block duration while minimizing haemodynamic side-effects. No patients experienced any neurologic sequelae. Evidence quality for sensory block was high according to the GRADE system. CONCLUSIONS: New evidence now indicates that perineural dexmedetomidine improves BPB onset, quality, and analgesia. However, these benefits should be weighed against increased risks of motor block prolongation and transient bradycardia and hypotension.
File Format	HTM / HTML
ISSN	00070912
e-ISSN	14716771
Journal	British Journal of Anaesthesia
Issue Number	2
Volume Number	118
Language	English
Publisher	Oxford University Press
Publisher Date	2017-02-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Anaesthesia
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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