Analgesic effects of dexmedetomidine combined with shoulder nerve blocks before arthroscopy: a meta-analysis of randomized-controlled trials.

IF 4.3 2区医学 Q1 ORTHOPEDICS

Efort Open Reviews Pub Date : 2025-07-01 DOI:10.1530/EOR-2024-0069

Wenhao Lu, Djandan Tadum Arthur Vithran, Bubacarr Jallow, Shide Jiang, Yusheng Li, Licheng Wei, Wenfeng Xiao

{"title":"Analgesic effects of dexmedetomidine combined with shoulder nerve blocks before arthroscopy: a meta-analysis of randomized-controlled trials.","authors":"Wenhao Lu, Djandan Tadum Arthur Vithran, Bubacarr Jallow, Shide Jiang, Yusheng Li, Licheng Wei, Wenfeng Xiao","doi":"10.1530/EOR-2024-0069","DOIUrl":null,"url":null,"abstract":"Purpose: Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.Methods: A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.Results: Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.Conclusions: This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"10 7","pages":"510-519"},"PeriodicalIF":4.3000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Efort Open Reviews","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1530/EOR-2024-0069","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.

Methods: A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.

Results: Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.

Conclusions: This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.

查看原文本刊更多论文

右美托咪定联合肩神经阻滞在关节镜检查前的镇痛效果：随机对照试验的荟萃分析。

目的：右美托咪定是肩关节镜神经阻滞麻醉中广泛应用的辅助药物。本研究旨在评估右美托咪定作为肩关节镜患者神经阻滞辅助治疗的镇痛效果。方法：全面检索PubMed/MEDLINE、Embase、Web of Science和Cochrane Library数据库，确定随机对照试验，比较右美托咪定增强肩关节镜神经阻滞与不使用右美托咪定的效果。本系统综述和荟萃分析遵循PRISMA指南。采用cochrane推荐的偏倚风险工具进行质量和偏倚评估。统计分析采用Review Manager 5.4（显著性水平P < 0.05），重点关注主要结局：镇痛持续时间和术后24 h吗啡消耗，次要结局：运动和感觉阻滞持续时间、视觉模拟量表疼痛评分和不良事件。结果：在检索到的307篇文献中，纳入了10项随机对照试验，涉及672例患者。补充右美托咪定可显著延长镇痛时间（MD = 3.58, 95% CI: 2.53 ~ 4.63, P < 0.00001, I 2 = 77%），减少术后吗啡用量（MD = -11.88, 95% CI: -17.25 ~ -6.52, P < 0.0001, I 2 = 41%）。此外，右美托咪定组在术后1、12和24 h的VAS疼痛评分较低。运动阻滞持续时间、心动过缓（P = 0.18）、低血压（P = 0.50）和恶心呕吐（P = 0.76）无显著差异。敏感性分析验证了这些发现的稳健性。结论：本荟萃分析支持右美托咪定作为肩关节镜神经阻滞的有效辅助。它增强术后镇痛，而不增加不良事件，如心动过缓、低血压、恶心和呕吐。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Efort Open Reviews Medicine-Orthopedics and Sports Medicine

CiteScore

6.60

自引率

2.90%

发文量

101

审稿时长

13 weeks

期刊介绍： EFORT Open Reviews publishes high-quality instructional review articles across the whole field of orthopaedics and traumatology. Commissioned, peer-reviewed articles from international experts summarize current knowledge and practice in orthopaedics, with the aim of providing systematic coverage of the field. All articles undergo rigorous scientific editing to ensure the highest standards of accuracy and clarity. This continuously published online journal is fully open access and will provide integrated CME. It is an authoritative resource for educating trainees and supports practising orthopaedic surgeons in keeping informed about the latest clinical and scientific advances. One print issue containing a selection of papers from the journal will be published each year to coincide with the EFORT Annual Congress. EFORT Open Reviews is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with The British Editorial Society of Bone & Joint Surgery.