ABSTRACT
Purpose
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.
Design
A Systematic Review and Meta-analysis.
Methods
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.
Findings
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).
Conclusions
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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References
- Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses.Br J Surg. 1994 Sep; 81: 1362-1365
- Pain and convalescence after laparoscopic cholecystectomy.Eur J Surg. 2001 Feb; 167: 84-96
- 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
- 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
- Abdominal field block: A new approach via the lumbar triangle.Anaesthesia. 2001 Oct; 56: 1024-1026
- 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
- 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
- Dexmedetomidine as an adjuvant to 0.5% ropivacaine in ultrasound-guided axillary brachial plexus block.J Clin Pharm Ther. 2018 Jun; 43: 348-352
- 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
- Comparison of block characteristics of spinal anesthesia following intravenous dexmedetomidine and clonidine.J Anaesthesiol Clin Pharmacol. 2016 Jul-Sep; 32: 339-343
- 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
- Posterior tibial nerve sensory blockade duration prolonged by adding dexmedetomidine to ropivacaine.Anesth Analg. 2012 Oct; 115: 958-962
Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). 2019.
- Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.Syst Rev. 2015 Jan 1; 4: 1
- Metaprop: A Stata command to perform meta-analysis of binomial data.Arch Public Health. 2014; 72: 39
- Metan: Fixed- and random-effects meta-analysis.The Stata J. 2008; 8: 3-28
- Bias in meta-analysis detected by a simple, graphical test.Br Med J. 1997; 315: 629-634
- Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics. 2000; 56: 455-463
- 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
- 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
- Analgesic effect of dexmedetomidine combined with ropivacaine in patients with laparoscopic cholecystectomy.Chinese J Med. 2021; 56: 775-778
- 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
- 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
- Effect of transversus abdominis plane block combined with dexmedetomidine on postoperative recovery in patients undergoing laparoscopic cholecystectomy.J New Med. 2019; 50: 681-685
- 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
- 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
- Analgesic effect of dexmedetomidine combined with ropivacaine transversal muscle block in patients with laparoscopic cholecystectomy.Zhejiang Clin Med J. 2017; 19: 1149-1151
- Anesthesic efficacy of dexmedetomidine mixed with ropivacaine for laparoscopic cholecystectomy.Pract J Med Pharm. 2018; 35: 211-213
- Analgesic effect of dexmedetomidine combined with ropivacaine in patients with laparoscopic cholecystectomy.Chinese Remedies Clinics. 2019; 19: 3558-3559
- Application of dexmedetomidine combined with ropivacaine intraperitoneal and incision-administered analgesia after laparoscopic cholecystectomy.Shandong Med J. 2014; 54: 72-74
- 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
- Multimodal analgesia for controlling acute postoperative pain.Curr Opin Anaesthesiol. 2009 Oct; 22: 588-593
- 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
- 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
- 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
- Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block.Anesth Analg. 2010 Dec; 111: 1548-1551
- Pharmacodynamics and pharmacokinetics of intramuscular dexmedetomidine.Clin Pharmacol Ther. 1992 Nov; 52: 537-546
- Changes in brain activation during sedation induced by dexmedetomidine.J Int Med Res. 2017 Jun; 45: 1158-1167
Article info
Publication history
Published online: January 27, 2023
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: None to report.
Funding: This paper did not receive funding.
Data Availability Statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Identification
Copyright
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
