Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies
Identifieur interne : 000981 ( Pmc/Checkpoint ); précédent : 000980; suivant : 000982Efficacy 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.
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DOI: 10.1007/s40122-016-0045-2
PubMed: 26861737
PubMed Central: 4912966
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of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Le Bot, Alix" sort="Le Bot, Alix" uniqKey="Le Bot A" first="Alix" last="Le Bot">Alix Le Bot</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Michelet, Daphnee" sort="Michelet, Daphnee" uniqKey="Michelet D" first="Daphnée" last="Michelet">Daphnée Michelet</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Hilly, Julie" sort="Hilly, Julie" uniqKey="Hilly J" first="Julie" last="Hilly">Julie Hilly</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Maesani, Mathieu" sort="Maesani, Mathieu" uniqKey="Maesani M" first="Mathieu" last="Maesani">Mathieu Maesani</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Brasher, Christopher" sort="Brasher, Christopher" uniqKey="Brasher C" first="Christopher" last="Brasher">Christopher Brasher</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne</wicri:regionArea><placeName><settlement type="city">Melbourne</settlement><region type="état">Victoria (État)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Dahmani, Souhayl" sort="Dahmani, Souhayl" uniqKey="Dahmani S" first="Souhayl" last="Dahmani">Souhayl Dahmani</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Anaesthesia and Intensive Care, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff3">Paris Diderot University, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris Diderot University, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff4">DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j">Pain and Therapy</title><idno type="ISSN">2193-8237</idno><idno type="eISSN">2193-651X</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><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><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mahmoud, M" uniqKey="Mahmoud M">M Mahmoud</name></author><author><name sortKey="Mason, Kp" uniqKey="Mason K">KP Mason</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mantz, J" uniqKey="Mantz J">J Mantz</name></author><author><name sortKey="Josserand, J" uniqKey="Josserand J">J Josserand</name></author><author><name sortKey="Hamada, S" uniqKey="Hamada S">S Hamada</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Le Bot, A" uniqKey="Le Bot A">A Le Bot</name></author><author><name sortKey="Michelet, D" uniqKey="Michelet D">D Michelet</name></author><author><name sortKey="Hilly, J" uniqKey="Hilly J">J Hilly</name></author><author><name sortKey="Maesani, M" 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<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><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><tree><country name="France"><region name="Île-de-France"><name sortKey="Bellon, Myriam" sort="Bellon, Myriam" uniqKey="Bellon M" first="Myriam" last="Bellon">Myriam Bellon</name></region><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><name sortKey="Dahmani, Souhayl" sort="Dahmani, Souhayl" uniqKey="Dahmani S" first="Souhayl" last="Dahmani">Souhayl Dahmani</name><name sortKey="Dahmani, Souhayl" sort="Dahmani, Souhayl" uniqKey="Dahmani S" first="Souhayl" last="Dahmani">Souhayl Dahmani</name><name sortKey="Hilly, Julie" sort="Hilly, Julie" uniqKey="Hilly J" first="Julie" last="Hilly">Julie Hilly</name><name sortKey="Hilly, Julie" sort="Hilly, Julie" uniqKey="Hilly J" first="Julie" last="Hilly">Julie Hilly</name><name sortKey="Le Bot, Alix" sort="Le Bot, Alix" uniqKey="Le Bot A" first="Alix" last="Le Bot">Alix Le Bot</name><name sortKey="Le Bot, Alix" sort="Le Bot, Alix" uniqKey="Le Bot A" first="Alix" last="Le Bot">Alix Le Bot</name><name sortKey="Maesani, Mathieu" sort="Maesani, Mathieu" uniqKey="Maesani M" first="Mathieu" last="Maesani">Mathieu Maesani</name><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></country><country name="Australie"><region name="Victoria (État)"><name sortKey="Brasher, Christopher" sort="Brasher, Christopher" uniqKey="Brasher C" first="Christopher" last="Brasher">Christopher Brasher</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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