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Systematic reviews

Open Access Special Issue

Comparison of dexmedetomidine and lipophilic opioids as adjuvants to local anesthetics for epidural labor analgesia: a meta-analysis of randomized controlled trials

  • Shi-ke Yang1
  • Min Liu1
  • Jie Chen1
  • Yuan-yuan Yang1
  • Fang-zheng Zhuan1
  • Wen-qun Sun1
  • De-zhi Mao1

1Department of Anesthesiology, Shanghai Zhongye Hospital, 200941 Shanghai, China

DOI: 10.22514/sv.2021.242

Submitted: 04 September 2021 Accepted: 27 September 2021

Online publish date: 13 December 2021

(This article belongs to the Special Issue Opioid Free Analgesia: new concept, new trends)

*Corresponding Author(s): Shi-ke Yang E-mail: shikey001@163.com

Abstract

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.


Keywords

Dexmedetomidine; Lipophilic opioids; Adjuvant; Epidural labor analgesia; Meta-analysis


Cite and Share

Shi-ke Yang,Min Liu,Jie Chen,Yuan-yuan Yang,Fang-zheng Zhuan,Wen-qun Sun,De-zhi Mao. Comparison of dexmedetomidine and lipophilic opioids as adjuvants to local anesthetics for epidural labor analgesia: a meta-analysis of randomized controlled trials. Signa Vitae. 2022.doi:10.22514/sv.2021.242.

References

[1] Kuczkowski KM. Ambulatory labor analgesia: what does an obstetrician need to know? Acta Obstetricia Et Gynecologica Scandinavica. 2004; 83: 415–424.

[2] Marucci M, Fiore T. Epidural analgesia for labour and delivery. Current evidence. Minerva Anesthesiol. 2004; 70: 643–650.

[3] Chau A, Tsen LC. Update on Modalities and Techniques for Labor Epidural Analgesia and Anesthesia. Advances in Anesthesia. 2018; 36: 139–162.

[4] Wong CA. Advances in labor analgesia. International journal of women’s health. 2010; 1: 139-154.

[5] Salomäki TE, Laitinen JO, Nuutinen LS. A Randomized Double-blind Comparison of Epidural versus Intravenous Fentanyl Infusion for Analgesia after Thoracotomy. Anesthesiology. 1991; 75: 790–795.

[6] Lorenzini C, Moreira LB, Ferreira MBC. Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery. Anaesthesia. 2002; 57: 424–428.

[7] Ranasinghe JS, Birnbach DJ. Progress in analgesia for labor: focus on neuraxial blocks. International Journal of Women’s Health. 2010; 1: 31–43.

[8] Zhang C, Li C, Pirrone M, Sun L, Mi W. Comparison of Dexmedeto-midine and Clonidine as Adjuvants to Local Anesthetics for Intrathecal Anesthesia: A Meta-Analysis of Randomized Controlled Trials. The Journal of Clinical Pharmacology. 2016; 56: 827–834.

[9] Selim MF, Elnabtity AM, Hasan AM. Comparative evaluation of epidural bupivacaine- dexmedetomidine and bupivacaine-fentanyl on Doppler velocimetry of uterine and umbilical arteries during labor. Journal of Prenatal Medicine. 2012; 6: 47–54.

[10] Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, et al. Dexmedetomidine and clonidine in epidural anaesthesia: a comparative evaluation. Indian Journal of Anaesthesia. 2011; 55: 116–121.

[11] Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: a wonder drug? Indian Journal of Anaesthesia. 2011; 55: 323–324.

[12] Marri SR. Adjuvant agents in regional anaesthesia. Anaesthesia & Intensive Care Medicine. 2012; 13: 559–562.

[13] Nair A, Sriprakash K. Dexmedetomidine in pregnancy: Review of literature and possible use. Journal of Obstetric Anaesthesia and Critical Care. 2013; 3: 3.

[14] Sia AT, Kwek K, Yeo GS. The in vitro effects of clonidine and dexmedetomidine on human myometrium. International Journal of Obstetric Anesthesia. 2005; 14: 104–107.

[15] Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. European Journal of Anaesthesiology. 2011; 28: 3–6.

[16] Congedo E, Sgreccia M, De Cosmo G. New Drugs for Epidural Analgesia. Current Drug Targets. 2009; 10: 696–706.

[17] Karuna H, Rajeshwari TN, Prabha P, Ramesh R, Anis N, Rinita P. Comparison between fentanyl 2 µg/mL versus dexmedetomidine 1.5 µg/mL as adjuvants with isobaric bupivacaine 0.0625% in epidural labour analgesia. Journal of Evidence Based Medicine and Healthcare. 2016; 3: 4974–4980.

[18] Wangping Z, Ming R. Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study. Evidence-Based Complementary and Alternative Medicine. 2017; 2017: 7924148.

[19] Zhang X, Wang D, Shi M, Luo Y. Efficacy and Safety of Dexmedetomi-dine as an Adjuvant in Epidural Analgesia and Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clinical Drug Investigation. 2017; 37: 343–354.

[20] Moher D, Liberati A, Tetzlaff J, Altman DG, Group P, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. British Medical Journal. 2009; 339: b2535.

[21] Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011. Available at: https://handbook-5- 1.cochrane.org/ (Accessed: 12 June 2021).

[22] Brok J, Thorlund K, Gluud C, Wetterslev J. Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. Journal of Clinical Epidemiology. 2008; 61: 763–769.

[23] Zhang T, Yu Y, Zhang W, Zhu J. Comparison of dexmedetomidine and sufentanil as adjuvants to local anesthetic for epidural labor analgesia: a randomized controlled trial. Drug Design, Development and Therapy. 2019; 13: 117–1175.

[24] Cheng Q, Bi X, Zhang W, Lu Y, Tian H. Dexmedetomidine versus sufentanil with high‐ or low‐concentration ropivacaine for labor epidural analgesia: a randomized trial. Journal of Obstetrics and Gynaecology Research. 2019; 45: 2193–2201.

[25] Soliman R, Zohry G. Assessment the effect of fentanyl and dexmedetomi-dine as adjuvant to epidural bupivacaine in parturients undergoing normal labour. Journal of Anesthesiology & Clinical Science. 2016; 5: 1–7.

[26] Huang Y, Liu Y, Li X, Yang L, Chen N. Application of levobupivacaine combined with dexmedetomidine in labor analgesia and its influence on mother and infant. International Journal of Anaesthesiology and Resuscitation. 2016; 37: 888–891. (In Chinese)

[27] X Zhu, Wang Y, Wang Z, Cai H, Zhu Q, Guo X. Application of epidural labor analgesia with dexmedetomidine or sufentanil combined with ropivacaine. Jiangsu Medical Journal. 2018; 44: 681–684. (In Chinese)

[28] Mao S, Zhang W. Comparison of epidural dexmedetomidine or sufentanil combined with ropivacine during labor analgesia. Chinese Journal of New Drugs and Clinical Remedies. 2017; 36: 736–739. (In Chinese)

[29] Shen S, Wang J. Observation on Epidural Injection of Ropivacaine Combined with Dexmedetomidine in Labor Analgesia. Chinese Journal of Modern Applied Pharmacy. 2020; 37: 3025–3029. (In Chinese)

[30] Tang Y, Pan X, Liu Q. Clinical study of dexmedetomidine combined with ropivacaine programmed intermittent epidural bolus for labor analgesia. Chinese Journal of Family Planning & Gynecotokology. 2019; 11: 53–56, 61. (In Chinese)

[31] Yu C, Liu X, Cai X, Liu J, Zhu N. Clinical application of dexmedeto-midine combined with ropivacaine for programmed intermittent epidural bolus in labor analgesia. Journal of Wenzhou Medical University. 2020; 50: 748–752. (In Chinese)

[32] Todd KH, Funk JP. The Minimum Clinically Important Difference in Physician-assigned Visual Analog Pain Scores. Academic Emergency Medicine. 1996; 3: 142–146.

[33] Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. The Cochrane database of systematic reviews. 2018; 5: CD000331.

[34] Khanna P, Jain S, Thariani K, Sharma S, Singh AK. Epidural Fever: Hiding in the Shadows. Turkish Journal of Anaesthesiology and Reanimation. 2020; 48: 350–355.

[35] Konakci S, Adanir T, Yilmaz G, Rezanko T. The efficacy and neurotoxicity of dexmedetomidine administered via the epidural route. European Journal of Anaesthesiology. 2008; 25: 403–409.

[36] Wang H, Zhang G, Dai W, Shu L, Wei Q, Zheng R, et al. Dose-dependent neurotoxicity caused by the addition of perineural dexmedetomidine to ropivacaine for continuous femoral nerve block in rabbits. Journal of International Medical Research. 2019; 47: 2562–2570.


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