Iosifina KARMANIOLOU, Chryssoula STAIKOU, Pavol SURDA

The Role of Dexmedetomidine as an Additive to Intravenous RegionalAnesthesia: A Systematic Review and Meta-analysis

Background: Intravenous Regional Anesthesia (IVRA) is a reliableand cost-effective anesthetic method for minor surgical procedures tothe extremities. Limitations of this block include tourniquet discomfort,short duration of anesthesia, and absence of postoperative analgesia.Dexmedetomidine has been used as an adjuvant to minimize thesenegative characteristics with inconclusive results. Aim: To perform a systematic review of the existing evidence on therole of dexmedetomidine as an additive to intravenous regional anes thesia in upper limb surgery. Study Design: Systematic Review and Meta-analysis. Methods: The databases searched were MEDLINE, Embase, PubMed,CINAHL, Cochrane Database of Systematic Reviews, CochraneCentral Register of Controlled Trials databases, and clinicaltrials. gov (1990-2019). Seven randomized controlled trials (RCTs) wereincluded. We analyzed the duration of analgesia, onset time of sensoryand motor block, intraoperative tourniquet pain scores, the incidenceof tourniquet pain, need for rescue analgesia, intraoperative rescueanalgesia consumption, sedation scores, postoperative pain scores, andanesthesia quality. Results: Intraoperative analgesia duration (MD 11.08 min; 95% CI5.42, 16.75; P < .0001) was longer and sensory block onset time (MD−2.10 min; 95% CI −3.345, −0.86; P = .00009) was shorter in thedexmedetomidine group. Anesthesia quality scores (MD 0.58; 95% CI0.47, 0.70; P < .00001) and postoperative sedation scores (MD 1.03;95% CI 0.88, 1.24; P < .00001) were significantly higher. There wasa significant reduction in intraoperative rescue analgesia consumption(MD −19.70 mg; 95% CI −24.15, −15.26; P < .00001) in the dexme detomidine group. The risk of tourniquet pain as well as postoperativepain scores were lower in favor of dexmedetomidine. The addition ofdexmedetomidine to IVRA slightly increased the risk of sedation. Alimitation of our study is that some of the interesting outcomes derivefrom a small number of RCTs. Conclusion: The addition of dexmedetomidine to IVRA amelioratesthe block’s characteristics and carries a low risk of potential side effects.

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