Comparison of dexmedetomidine and lipophilic opioids as adjuvants to local anesthetics for epidural labor analgesia: a meta-analysis of randomized controlled trials
1Department of Anesthesiology, Shanghai Zhongye Hospital, 200941 Shanghai, China
DOI: 10.22514/sv.2021.242 Vol.19,Issue 1,January 2023 pp.23-33
Submitted: 04 September 2021 Accepted: 27 September 2021
Published: 08 January 2023
The aim of this study is to evaluate the benefits of dexmedetomidine in epidural labor analgesia compared with lipophilic opioids. The databases of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and SinoMed were searched from inception to Mar. 25, 2021 for randomized controlled trials (RCT) that assessed dexmedetomidine versus lipophilic opioids as adjuvants to local anesthetics in epidural labor analgesia. Meta-analyses were conducted with RevMan 5.3, and a random-effects model was adopted. A total of 11 RCTs involving 1099 parturients were enrolled. The results showed that, compared with the control group, dexmedetomidine significantly reduced Visual Analogue Scale (VAS) scores both at 30 minutes after induction [weighted mean difference (WMD) = –0.40, 95% CI: –0.61 to –0.20] and on delivery (WMD = –0.83, 95% CI: –1.15 to –0.50), reduced analgesic consumption (WMD = –6.29 mL, 95% CI: –10.49 to –2.10), shortened the duration of the first (WMD = –9.58 minutes, 95% CI: –18.12 to –1.04) and second (WMD = –1.66 minutes, 95%CI: –3.20 to –0.12) stage of labor, increased maternal bradycardia [risk ratio (RR) = 2.44, 95% CI: 1.31 to 4.53] and motor blockade (RR = 5.30, 95% CI: 2.21 to 12.73), reduced nausea/vomiting (RR = 0.34, 95% CI: 0.20 to 0.57), pruritis (RR= 0.19, 95%CI: 0.06 to 0.58) and shivering (RR = 0.37, 95% CI: 0.18 to 0.77). There was no significant difference between groups in the rate of instrumental delivery (p = 0.68), and cesarean delivery (p = 0.40), Apgar scores at 1 minute (p = 0.24), at 5 minutes (p = 0.36), and the umbilical arterial PH (p = 0.16). In summary, compared to lipophilic opioids, dexmedetomidine for epidural labor analgesia reduced analgesic agent consumption and resulted in fewer maternal complications.
Dexmedetomidine; Lipophilic opioids; Adjuvant; Epidural labor analgesia; Meta-analysis
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