Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies
Identifieur interne : 000C65 ( Pmc/Curation ); précédent : 000C64; suivant : 000C66Efficacy 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
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<series><title level="j">Pain and Therapy</title>
<idno type="ISSN">2193-8237</idno>
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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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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Pain Ther</journal-id>
<journal-id journal-id-type="iso-abbrev">Pain Ther</journal-id>
<journal-title-group><journal-title>Pain and Therapy</journal-title>
</journal-title-group>
<issn pub-type="ppub">2193-8237</issn>
<issn pub-type="epub">2193-651X</issn>
<publisher><publisher-name>Springer Healthcare</publisher-name>
<publisher-loc>Cheshire</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">26861737</article-id>
<article-id pub-id-type="pmc">4912966</article-id>
<article-id pub-id-type="publisher-id">45</article-id>
<article-id pub-id-type="doi">10.1007/s40122-016-0045-2</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group><article-title>Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Bellon</surname>
<given-names>Myriam</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Le Bot</surname>
<given-names>Alix</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Michelet</surname>
<given-names>Daphnée</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hilly</surname>
<given-names>Julie</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Maesani</surname>
<given-names>Mathieu</given-names>
</name>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Brasher</surname>
<given-names>Christopher</given-names>
</name>
<xref ref-type="aff" rid="Aff2"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Dahmani</surname>
<given-names>Souhayl</given-names>
</name>
<address><email>souhayl.dahmani@rdb.aphp.fr</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff3"></xref>
<xref ref-type="aff" rid="Aff4"></xref>
</contrib>
<aff id="Aff1"><label></label>
Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris, France</aff>
<aff id="Aff2"><label></label>
Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Australia</aff>
<aff id="Aff3"><label></label>
Paris Diderot University, Paris, France</aff>
<aff id="Aff4"><label></label>
DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris, France</aff>
</contrib-group>
<pub-date pub-type="epub"><day>10</day>
<month>2</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>10</day>
<month>2</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="ppub"><month>6</month>
<year>2016</year>
</pub-date>
<volume>5</volume>
<issue>1</issue>
<fpage>63</fpage>
<lpage>80</lpage>
<history><date date-type="received"><day>16</day>
<month>12</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s) 2016</copyright-statement>
</permissions>
<abstract id="Abs1"><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>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Analgesia</kwd>
<kwd>Children</kwd>
<kwd>Dexmedetomidine</kwd>
<kwd>Meta-analysis</kwd>
<kwd>Postoperative pain</kwd>
<kwd>Recovery</kwd>
</kwd-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© Springer Healthcare 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>
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