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Meta-Analysis
. 2020 Oct 19;15(10):e0240561.
doi: 10.1371/journal.pone.0240561. eCollection 2020.

Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: A systematic review and meta-analysis

Zi-Fang Zhao  1 , Lei Du  2 , Dong-Xin Wang  1
Affiliations
Meta-Analysis

Effects of dexmedetomidine as a perineural adjuvant for femoral nerve block: A systematic review and meta-analysis

Zi-Fang Zhao et al. PLoS One. .

Abstract

Background: Femoral nerve block (FNB) is one of the first-line analgesic methods for patients following lower extremity surgery. However, FNB with local anesthetics alone exert limited potency and supplemental opioids are often required. Dexmedetomidine (DEX) has been used to improve the analgesic effects of FNB. The present systematic review and meta-analysis were conducted to evaluate the effectiveness of DEX as an adjuvant to local anesthetics for FNB.

Methods: Randomized controlled trials comparing the effects of DEX versus sham control in combination with local anesthetics for FNB were included in this meta-analysis. Postoperative pain scores, duration of analgesic effects, and postoperative narcotic consumption were outcomes of interest. This research was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements.

Results: A total of 9 studies encompassing 580 participants were included for data synthesis after critical evaluation. DEX as an adjuvant with local anesthetics for FNB significantly relieved pain intensity at 12, 24 and 48 hours after surgery, both at rest (standardized mean difference -1.34 [95% CI -1.87 to -0.82], P<0.00001 at 12 h; -1.26 [-1.90 to -0.0.63], P<0.0001 at 24 h; and -1.34; [-2.18 to -0.50], P = 0.002 at 48 h) and with movement (-1.30 [-2.17 to -0.43], P = 0.004 at 12 h; -1.02 [-1.31 to -0.72], P<0.00001 at 24h; and -1.33 [-2.03 to -0.63], P = 0.0002); it also significantly prolonged analgesic duration (mean difference 7.23 h [95% CI 4.07 to 10.39], P<0.00001) and decreased opioid consumption (mean difference of morphine equivalent -12.13 mg [95% CI -23.36 to -0.89], P<0.00001). Regarding safety, DEX use increased the rate of hypotension (odds ratio 4.10, 95% CI 1.40 to 12.01, P = 0.01).

Conclusion: DEX as an adjuvant to local anesthetics for FNB improves analgesia, prolongs analgesic duration and reduces supplemental opioid consumption; but increases hypotension.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram showing literature search results.
Fig 2
Fig 2. Risk-of-bias evaluation for all included trials.
Fig 3
Fig 3. Effects of dexmedetomidine versus placebo on the postoperative pain scores in resting state.
Fig 4
Fig 4. Forest plots of the effects of dexmedetomidine versus placebo on the postoperative pain scores in active state.
Fig 5
Fig 5. Dexmedetomidine versus placebo on the analgesic duration of femoral nerve block.
Fig 6
Fig 6. Dexmedetomidine versus placebo on the postoperative consumption of morphine-equivalents.
Fig 7
Fig 7. Incidence rates of adverse effects.
PONV indicates postoperative nausea and vomiting.
See this image and copyright information in PMC

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