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Dexmedetomidine as an adjunct to peripheral nerve blocks in pediatric patients

  • Meta-analysis
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Combining local anesthetics with dexmedetomidine (DEX) for nerve blocks has been tested and confirmed as an alternative technique to strengthen analgesia in adults, but the evidence supported this proposal in pediatrics was not convincing enough. Thus, we intend to conduct a meta-analysis to make an appraisal of the effects of DEX as a local anesthetic adjuvant on peripheral nerve blocks in children.

Methods

The analysis has been registered on https://www.crd.york.ac.uk/prospero/ with the registration number CRD42021254029 on June 10th, 2021. PubMed, Ovid MEDLINE, Embase and Cochrane central register were searched for the randomized controlled trials (RCTs) that are relevant to child/pain/DEX or block up to April 30, 2021.

Results

Eight RCTs were included for data analysis. The pooled results showed a significantly reduced number of patients who required postoperative analgesics within DEX groups [odds ratio = 0.1, 95% confidence interval (CI) 0.03–0.32, P < 0.001]. And DEX significantly prolonged the duration of analgesia of local anesthetics in the meantime [standardized mean difference (SMD) = 4.93, 95% CI 3.02–6.83, P < 0.001]. Nevertheless, adding DEX as an adjunct to local anesthetics would significantly decrease heart rate (SMD = − 0.95, 95% CI − 1.45 to − 0.45, P < 0.001) and increase sedation score (SMD = 1.6, 95% CI 0.53–2.66, P = 0.003) simultaneously.

Conclusions

Adding DEX as an adjunct to peripheral nerve blocks can prolong analgesia until postoperative 8 hours in pediatric patients. However, the benefits should be weighed against the increasing risk of bradycardia and sedation in critical children.

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Data availability

The datasets are available from the corresponding author on reasonable request.

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Funding

This study was supported by the Special Scientific Research Projects in Orthopedics of Sichuan Medical Association which was supported by Yu Cui (No. 2019SAT19).

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Authors and Affiliations

  1. Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, No. 1617, Riyue Avenue, Qingyang District, Chengdu, 610091, China

    Jing Yang, Yu Cui, Rong Cao, Qing-Hua Huang & Qian-Qian Zhang

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  1. Jing Yang
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  2. Yu Cui
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  3. Rong Cao
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  4. Qing-Hua Huang
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  5. Qian-Qian Zhang
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Contributions

YJ contributed to literature search, data extraction, software, data analysis, and writing of the original draft. CY contributed to conceptualization, funding acquisition, methodology, and reviewing and editing. CR contributed to supervision, reviewing and editing. HQH contributed to software, data analysis, and writing of the original draft. ZQQ contributed to literature search, data extraction, and writing of the original draft. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Yu Cui.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no conflict of interest to declare.

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Yang, J., Cui, Y., Cao, R. et al. Dexmedetomidine as an adjunct to peripheral nerve blocks in pediatric patients. World J Pediatr 18, 251–262 (2022). https://doi.org/10.1007/s12519-021-00507-z

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  • DOI: https://doi.org/10.1007/s12519-021-00507-z

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