07 January 2019 : Meta-Analysis
The Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine on Caudal Epidural Block in Children: A Meta-Analysis
Zhenzhen Tu123ABCE*, Xingqin Tan143BCDF, Shangyingying Li1CDF, Jie Cui1DFDOI: 10.12659/MSM.913098
Med Sci Monit 2019; 25:165-173
Abstract
BACKGROUND: This meta-analysis was conducted to evaluate the analgesics effect and safety of dexmedetomidine (DEX) combined with bupivacaine (BU) on caudal epidural block.
MATERIAL AND METHODS: Published studies were identified using the PubMed, EMBASE, Web of Science, and the Cochrane Library from inception until October 2017. Relative risk (RR), the standardized mean difference (SMD), and the corresponding 95% confidence interval (CI) were calculated using the STATA 12.0.
RESULTS: Ten randomized controlled trials (RCTs) were selected for this meta-analysis, involving a total of 691 patients. There was a longer duration of postoperative analgesia in children receiving DEX (SMD=3.19, 95% CI: 2.16–4.22, P<0.001). Furthermore, there was a lower number of patients requiring rescue analgesics in the (BU) + (DEX) group (6 hours: RR=0.09, 95% CI: 0.05–0.17, P<0.001; 12 hours: RR=0.50, 95% CI: 0.32–0.79, P=0.003; 24 hours: RR=0.66, 95% CI: 0.51–0.85, P=0.002). Finally, the occurrence of adverse events, between BU and DEX + BU group, was not statistically significant (RR=0.96, 95% CI: 0.58–1.58, P>0.05).
CONCLUSIONS: DEX seems to be a promising adjuvant to BU increase duration of caudal analgesia without an increase in side effects in children. However, the result may be influenced by clinical heterogeneity. More large-scale, multicenter, approaching, double-blinded RCTs are required to confirm our results.
Keywords: children, Bupivacaine, Dexmedetomidine, Randomized controlled trial, Analgesia, Analgesics, Anesthesia, Epidural, Anesthetics, Local, Child, Child, Preschool, Infant, pain management, Pain, Postoperative
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