Analgesic Effects of Ropivacaine Combined With Dexmedetomidine in Transversus Abdominis Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis

  • Miao Zhu
    Department of Anesthesiology, the Sixth Hospital of Ningbo, Ningbo, Zhejiang, China
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  • Wenchao Sun
    Address correspondence to Wenchao Sun, Department of Anesthesiology, the Sixth Hospital of Ningbo, Zhongshan East Road, Fuming Street, Yinzhou District, Ningbo, Zhejiang 315000, China.
    Department of Anesthesiology, the Sixth Hospital of Ningbo, Ningbo, Zhejiang, China
    Search for articles by this author
Published:January 27, 2023DOI:



      This review aimed to conduct a meta-analysis of published randomized controlled studies (RCTs) comparing the effectiveness of dexmedetomidine (DEX) combined with ropivacaine versus single ropivacaine in transversus abdominis plane block (TAPB) for postoperative analgesia after laparoscopic cholecystectomy (LC). The purpose was to investigate whether DEX combined with ropivacaine in TAPB for postoperative analgesia in LC is superior to single ropivacaine administration.


      A Systematic Review and Meta-analysis.


      Five electronic database systems were searched for RCTs on the effects of DEX combined with ropivacaine (joint group) and single ropivacaine on postoperative analgesia in LC. The standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence interval (CI) of the indicators were calculated for comparison.


      As of December 23, 2021, 153 articles were retrieved, but only 16 articles were finally included in this meta-analysis. The results showed that compared with single ropivacaine, DEX combined with ropivacaine in TAPB had better analgesia and lighter sedative effect in patients after LC. After LC 2h(T1), 4h(T2), 8h(T3), 12h(T4) and 24h (T5), the joint group participants have lower VAS scores (T1: SMD = -0.32, 95%CI: -0.49, -0.14; T2: SMD = -1.11, 95%CI: -1.56, -0.65; T3: SMD = -2.88, 95%CI: -3.74, -2.02; T4: SMD = -2.56, 95%CI: -3.04, -2.08; T5: SMD = -1.44, 95%CI: -1.81, -1.06). Also, the Ramsay score of the joint group is higher than the single group (T1: SMD = 1.05, 95%CI: 0.39, 1.71; T2: SMD = 1.57, 95%CI: 0.57, 2.57; T3: SMD = 1.64, 95%CI: 0.65, 2.63; T4: SMD = 1.72, 95%CI: 0.54, 2.89; T5: SMD = 0.57, 95%CI: 0.21, 0.94).


      The results of this review and meta-analysis suggest that DEX combined with ropivacaine has less postoperative pain, more patients got the status of sober and cooperative, and longer postoperative analgesia lasted than ropivacaine alone in TAPB, especially in the group of combined treatment with 1.0 mcg/kg DEX. Furthermore, the flow dynamics of the two groups are stable, and there is no notable difference in the incidence of adverse reactions.
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        • Berggren U
        • Gordh T
        • Grama D
        Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses.
        Br J Surg. 1994 Sep; 81: 1362-1365
        • Bisgaard T
        • Kehlet H
        • Rosenberg J.
        Pain and convalescence after laparoscopic cholecystectomy.
        Eur J Surg. 2001 Feb; 167: 84-96
        • Raff M
        • Belbachir A
        • El-Tallawy S
        Intravenous oxycodone versus other intravenous strong opioids for acute postoperative pain control: A systematic review of randomized controlled trials.
        Pain Ther. 2019 Jun; 8: 19-39
        • Abdulla S
        • Eckhardt R
        • Netter U
        A randomized, double-blind, controlled trial on non-opioid analgesics and opioid consumption for postoperative pain relief after laparoscopic cholecystectomy.
        Acta Anaesthesiol Belg. 2012; 63: 43-50
        • Rafi AN
        Abdominal field block: A new approach via the lumbar triangle.
        Anaesthesia. 2001 Oct; 56: 1024-1026
        • Tolchard S
        • Davies R
        • Martindale S.
        Efficacy of the subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Comparison with conventional port-site infiltration.
        J Anaesthesiol Clin Pharmacol. 2012 Jul; 28: 339-343
        • Johnson MZ
        • O'Connor TC
        Excellent postoperative analgesia with the addition of hyaluronidase to lignocaine for subcostal TAP block used in conjunction with systemic analgesia for laparoscopic cholecystectomy.
        BMJ Case Rep. 2014 Feb 7; 2014bcr2013202911
        • Koraki E
        • Stachtari C
        • Kapsokalyvas I
        • et al.
        Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block.
        J Clin Pharm Ther. 2018 Jun; 43: 348-352
        • Moshiri E
        • Modir H
        • Bagheri N
        Premedication effect of dexmedetomidine and alfentanil on seizure time, recovery duration, and hemodynamic responses in electroconvulsive therapy.
        Ann Card Anaesth. 2016 Apr-Jun; 19: 263-268
        • Agrawal A
        • Agrawal S
        • Payal YS.
        Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine.
        J Anaesthesiol Clin Pharmacol. 2016 Jul-Sep; 32: 339-343
        • Sharma B
        • Rupal S
        • Swami AC
        Effect of addition of dexmedetomidine to ropivacaine 0.2% for femoral nerve block in patients undergoing unilateral total knee replacement: A randomised double-blind study.
        Indian J Anaesth. 2016 Jun; 60: 403-408
        • Rancourt MP
        • Albert NT
        • Côté M
        Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine.
        Anesth Analg. 2012 Oct; 115: 958-962
      1. Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). 2019.

        • Moher D
        • Shamseer L
        • Clarke M
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015 Jan 1; 4: 1
        • Nyaga VN
        • Arbyn M
        • Aerts M.
        Metaprop: A Stata command to perform meta-analysis of binomial data.
        Arch Public Health. 2014; 72: 39
        • Harris RJ
        • Deeks JJ
        • Altman DG
        Metan: Fixed- and random-effects meta-analysis.
        The Stata J. 2008; 8: 3-28
        • Egger M
        • Davey Smith G
        • Schneider M
        Bias in meta-analysis detected by a simple, graphical test.
        Br Med J. 1997; 315: 629-634
        • Duval S
        • Tweedie R.
        Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.
        Biometrics. 2000; 56: 455-463
        • Lin XF
        • Luo DX
        • Hui Q.
        Effect of B-mode ultrasound-guided multipoint transverse abdominal planar block combined with dexmedetomidine on recovery after laparoscopic cholecystectomy.
        Guangdong Med J. 2019; 40: 990-993
        • Tan SS
        • Hu TT
        • Yao ZM.
        Effect of different doses of dexmedetomidine combined with ropivacaine intraperitoneal atomization and incision injection on postoperative analgesia after laparoscopic cholecystectomy.
        Chin J Mod Drug Appl. 2018; 12: 8-11
        • Zhao NN
        • Li H
        • Shi YB
        Analgesic effect of dexmedetomidine combined with ropivacaine in patients with laparoscopic cholecystectomy.
        Chinese J Med. 2021; 56: 775-778
        • Tan HB
        • Chen L
        • Zhao Q
        Effect of different doses of dexmedetomidine combined with transversus abdominis plane block on rapid recovery of patients undergoing laparoscopic cholecystectomy.
        China Medicine. 2020; 15: 745-748
        • Yuan XJ.
        Influence of transabdominal fascia block plus intraoperative intravenous infusion of dexmedetomidine on postoperative recovery quality of cholecystolithiasis patients complicated with cholecystitis after anesthesia induction.
        Acta Medicinae Sinica. 2020; 33: 70-74
        • Liao ZX
        • Zhou LS
        • Wen J
        Effect of transversus abdominis plane block combined with dexmedetomidine on postoperative recovery in patients undergoing laparoscopic cholecystectomy.
        J New Med. 2019; 50: 681-685
        • Zhang HL
        • Zhao LQ.
        Analgesic effect of intraperitoneal spray of ropivacaine combined with dexmedetomidine on postoperative pain after laparoscopic cholecystectomy.
        Med J Nat Defend Forces Northwest China. 2016; 37: 442-444
        • Zhang XQ
        • Zhao Q
        • Li YF
        Effects of dexmedetomidine combined with ropivacaine mesylate on laparoscopic cholecystectomy in transverse abdominal muscle plane combined with rectus sheath blockade.
        Chinese J Med. 2020; 55: 108-112
        • Zhang YP
        • Lou Z.
        Analgesic effect of dexmedetomidine combined with ropivacaine transversal muscle block in patients with laparoscopic cholecystectomy.
        Zhejiang Clin Med J. 2017; 19: 1149-1151
        • Tian XD
        • Zhang Y
        • Chen YL
        Anesthesic efficacy of dexmedetomidine mixed with ropivacaine for laparoscopic cholecystectomy.
        Pract J Med Pharm. 2018; 35: 211-213
        • Zhu HB
        • Zheng SS
        • Zhang HY.
        Analgesic effect of dexmedetomidine combined with ropivacaine in patients with laparoscopic cholecystectomy.
        Chinese Remedies Clinics. 2019; 19: 3558-3559
        • Zhou Y
        • Si YY
        • Li SH.
        Application of dexmedetomidine combined with ropivacaine intraperitoneal and incision-administered analgesia after laparoscopic cholecystectomy.
        Shandong Med J. 2014; 54: 72-74
        • Sarvesh B
        • Shivaramu BT
        • Sharma K
        Addition of dexmedetomidine to ropivacaine in subcostal transversus abdominis plane block potentiates postoperative analgesia among laparoscopic cholecystectomy patients: A prospective randomized controlled trial.
        Anesth Essays Res. 2018 Oct-Dec; 12: 809-813
        • Buvanendran A
        • Kroin JS.
        Multimodal analgesia for controlling acute postoperative pain.
        Curr Opin Anaesthesiol. 2009 Oct; 22: 588-593
        • El-Dawlatly AA
        • Turkistani A
        • Kettner SC
        • et al.
        Ultrasound-guided transversus abdominis plane block: Description of a new technique and comparison with conventional systemic analgesia during laparoscopic cholecystectomy.
        Br J Anaesth. 2009 Jun; 102: 763-767
        • Børglum J
        • Jensen K
        • Christensen AF
        Distribution patterns, dermatomal anesthesia, and ropivacaine serum concentrations after bilateral dual transversus abdominis plane block.
        Reg Anesth Pain Med. 2012 May-Jun; 37: 294-301
        • Brummett CM
        • Padda AK
        • Amodeo FS
        Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat.
        Anesthesiology. 2009 Nov; 111: 1111-1119
        • Esmaoglu A
        • Yegenoglu F
        • Akin A
        Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block.
        Anesth Analg. 2010 Dec; 111: 1548-1551
        • Scheinin H
        • Karhuvaara S
        • Olkkola KT
        Pharmacodynamics and pharmacokinetics of intramuscular dexmedetomidine.
        Clin Pharmacol Ther. 1992 Nov; 52: 537-546
        • Kim WH
        • Cho D
        • Lee B
        Changes in brain activation during sedation induced by dexmedetomidine.
        J Int Med Res. 2017 Jun; 45: 1158-1167