Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies
Identifieur interne : 002010 ( Main/Exploration ); précédent : 002009; suivant : 002011Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies
Auteurs : Myriam Bellon [France] ; Alix Le Bot [France] ; Daphnée Michelet [France] ; Julie Hilly [France] ; Mathieu Maesani [France] ; Christopher Brasher [Australie, France] ; Souhayl Dahmani [France]Source :
- Pain and Therapy [ 2193-8237 ] ; 2016.
Abstract
Dexmedetomidine (Dex) has sedative, analgesic, and anesthetic-sparing effects. This meta-analysis examines demonstrated intraoperative and postoperative effects of intraoperative Dex administration during pediatric surgery.
A search for randomized placebo-controlled trials was conducted to identify clinical trials examining intraoperative Dex use in children, infants, and neonates. Primary outcome was postoperative opioid consumption; secondary outcomes were: postoperative pain intensity and postoperative nausea and vomiting (PONV).
Fourteen randomized controlled trials performed during painful procedures were analyzed. Intraoperative Dex administration was associated with significantly reduced postoperative opioid consumption in the postanesthesia care unit [PACU; risk ratio (RR) = 0.31 (0.17, 0.59),
This meta-analysis shows that intraoperative Dex administration in children reduces postoperative opioids consumption and postoperative pain in PACU. According to our results, optimal bolus dose was found to be ≥0.5 µg/kg. Future studies have to explore this particular point and the postoperative analgesic effects of Dex during longer periods.
Url:
DOI: 10.1007/s40122-016-0045-2
PubMed: 26861737
PubMed Central: 4912966
Affiliations:
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<front><div type="abstract" xml:lang="en"><sec><title>Introduction</title>
<p>Dexmedetomidine (Dex) has sedative, analgesic, and anesthetic-sparing effects. This meta-analysis examines demonstrated intraoperative and postoperative effects of intraoperative Dex administration during pediatric surgery.</p>
</sec>
<sec><title>Methods</title>
<p>A search for randomized placebo-controlled trials was conducted to identify clinical trials examining intraoperative Dex use in children, infants, and neonates. Primary outcome was postoperative opioid consumption; secondary outcomes were: postoperative pain intensity and postoperative nausea and vomiting (PONV).</p>
</sec>
<sec><title>Results</title>
<p>Fourteen randomized controlled trials performed during painful procedures were analyzed. Intraoperative Dex administration was associated with significantly reduced postoperative opioid consumption in the postanesthesia care unit [PACU; risk ratio (RR) = 0.31 (0.17, 0.59), <italic>I</italic>
<sup>2</sup>
= 76%, <italic>p</italic>
< 0.0001 and cumulative <italic>z</italic>
score using trial sequential analysis], decreased pain intensity in PACU [standardized mean difference (SMD) = −1.18 (−1.88, −0.48), <italic>I</italic>
<sup>2</sup>
= 91%, <italic>p</italic>
< 0.0001] but had no effect upon PONV incidence [RR = 0.67 (0.41, 1.08), <italic>I</italic>
<sup>2</sup>
= 0%, <italic>p</italic>
= 0.48]. Subgroup analyses found administering Dex during adenotonsillectomy and using a bolus <0.5 µg/kg (irrespective to the use of a continuous administration) without effects on studies outcomes. Heterogeneity was high among results and a high suspicion of publication bias was present for all analyzed outcomes.</p>
</sec>
<sec><title>Conclusions</title>
<p>This meta-analysis shows that intraoperative Dex administration in children reduces postoperative opioids consumption and postoperative pain in PACU. According to our results, optimal bolus dose was found to be ≥0.5 µg/kg. Future studies have to explore this particular point and the postoperative analgesic effects of Dex during longer periods.</p>
</sec>
</div>
</front>
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</TEI>
<affiliations><list><country><li>Australie</li>
<li>France</li>
</country>
<region><li>Victoria (État)</li>
<li>Île-de-France</li>
</region>
<settlement><li>Melbourne</li>
<li>Paris</li>
</settlement>
</list>
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<name sortKey="Bellon, Myriam" sort="Bellon, Myriam" uniqKey="Bellon M" first="Myriam" last="Bellon">Myriam Bellon</name>
<name sortKey="Brasher, Christopher" sort="Brasher, Christopher" uniqKey="Brasher C" first="Christopher" last="Brasher">Christopher Brasher</name>
<name sortKey="Dahmani, Souhayl" sort="Dahmani, Souhayl" uniqKey="Dahmani S" first="Souhayl" last="Dahmani">Souhayl Dahmani</name>
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<name sortKey="Maesani, Mathieu" sort="Maesani, Mathieu" uniqKey="Maesani M" first="Mathieu" last="Maesani">Mathieu Maesani</name>
<name sortKey="Michelet, Daphnee" sort="Michelet, Daphnee" uniqKey="Michelet D" first="Daphnée" last="Michelet">Daphnée Michelet</name>
<name sortKey="Michelet, Daphnee" sort="Michelet, Daphnee" uniqKey="Michelet D" first="Daphnée" last="Michelet">Daphnée Michelet</name>
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<country name="Australie"><region name="Victoria (État)"><name sortKey="Brasher, Christopher" sort="Brasher, Christopher" uniqKey="Brasher C" first="Christopher" last="Brasher">Christopher Brasher</name>
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</country>
</tree>
</affiliations>
</record>
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