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      Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

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          Abstract

          Objective

          To evaluate the efficacy and safety of spinal anaesthesia using dexmedetomidine for caesarean section.

          Methods

          PubMed, The Cochrane Library, and CNKI were searched for relevant literature.

          Results

          The incidence of nausea and vomiting in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.21, 95% CI: 0.12–0.35, P < 0.00001). No difference was found in the incidence of pruritus between the two groups (OR = 1.21, 95% CI: 0.36–4.09, P = 0.76).The dexmedetomidine group had a higher incidence of bradycardia than did the control group (OR = 2.20, 95% CI: 1.02–4.77, P = 0.05). The incidence of shivering in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.20, 95% CI: 0.13–0.32, P < 0.00001). The incidence of hypotension was not different between the two groups (OR = 0.88, 95% CI: 0.49–1.56, P = 0.65).

          Conclusion

          Dexmedetomidine can decrease the incidence of nausea, vomiting, bradycardia, and shivering with spinal anaesthesia during caesarean section.

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          Most cited references23

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          Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children.

          Alaa A Abd-Elsayed, Ashraf Ali M. A. El Shorbgy, S. K. El-Labany … (2009)
          Caudal block is a common technique for paediatric analgesia but with the disadvantage of short duration of action after single injection. Caudal dexmedetomidine and clonidine could offer significant analgesic benefits. We compared the analgesic effects and side-effects of dexmedetomidine and clonidine added to bupivacaine in paediatric patients undergoing lower abdominal surgeries. Sixty patients (6 months to 6 yr) were evenly and randomly assigned into three groups in a double-blinded manner. After sevoflurane in oxygen anaesthesia, each patient received a single caudal dose of bupivacaine 0.25% (1 ml kg(-1)) combined with either dexmedetomidine 2 microg kg(-1) in normal saline 1 ml, clonidine 2 microg kg(-1) in normal saline 1 ml, or corresponding volume of normal saline according to group assignment. Haemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, use of analgesics, and side-effects were assessed during the first 24 h. Addition of dexmedetomidine or clonidine to caudal bupivacaine significantly promoted analgesia time [median (95% confidence interval, CI): 16 (14-18) and 12 (3-21) h, respectively] than the use of bupivacaine alone [median (95% CI): 5 (4-6) h] with P<0.001. However, there was no statistically significant difference between dexmedetomidine and clonidine as regards the analgesia time (P=0.796). No significant difference was observed in incidence of haemodynamic changes or side-effects. Addition of dexmedetomidine or clonidine to caudal bupivacaine significantly promoted analgesia in children undergoing lower abdominal surgeries with no significant advantage of dexmedetomidine over clonidine and without an increase in incidence of side-effects.
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            Perioperative shivering: physiology and pharmacology.

            D Sessler, Jan-Philip M Witte (2002)
            Article 0 comments Cited 81 times – based on 0 reviews     Review now
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              Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study

              Seyed Hamid Reza Faiz, Poupak Rahimzadeh, Farnad Imani … (2013)
              Background Regional anesthesia is known to significantly impair thermoregulation and predispose patients to hypothermia. We hypothesized that the addition of an intrathecal injection of magnesium sulfate (MgSO4) to bupivacaine would improve perioperative shivering in female patients undergoing elective caesarean section. Methods In a block-randomized, double-blinded, controlled trial 72 patients scheduled for elective caesarean section with spinal anesthesia were separated into two groups. In the treatment group, 2 ml of 0.5% bupivacaine plus 25 mg MgSO4 (0.5 ml) were injected intrathecally, and in the control group 2 ml of 0.5% bupivacaine plus 0.5 ml normal saline were injected intrathecally. Core temperature was measured before and after drug injection at predetermined intervals. Sedation was graded using the Ramsay sedation scale. Results No significant intergroup differences in appearance of shivering were seen immediately or at 5, 30, 40, 50, 60, and 90 min after block administration. However, at 10, 15, and 20 min post block, there was a significant difference in shivering. The group administered MgSO4 showed lower shivering grades compared with the control group. Core temperature was significantly reduced in the MgSO4 group compared to the normal saline group 30 min after blocking. Conclusions Intrathecal injection of MgSO4 improved perioperative shivering in female patients undergoing elective caesarean section.
              Article 0 comments Cited 32 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J. Int. Med. Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 28 May 2017
                Publication date (Print): June 2017
                Volume: 45
                Issue: 3
                Pages: 924-932
                Affiliations
                [1 ]Zhaoqing Medical College, Zhaoqing, China
                [2 ]Department of Anesthesiology, The First People’s Hospital of Changde, Changde, China
                Author notes
                [*]

                These authors contributed equally to this work.

                [*]Chengmao Zhou, Zhaoqing Medical College, No. 5 Xijiangnan Road, Zhaqing, Guangdong, China. Email: 564099474@ 123456qq.com
                Article
                Publisher ID: 10.1177_0300060517708945
                DOI: 10.1177/0300060517708945
                PMC ID: 5536398
                PubMed ID: 28553766
                SO-VID: bde70480-0fc7-430c-881c-9245c17f07d9
                Copyright © © The Author(s) 2017
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 8 February 2017
                Date accepted : 18 April 2017
                Categories
                Subject: Meta-Analysis

                Keywords: dexmedetomidine,caesarean section,spinal anaesthesia,meta-analysis
                Data availability:
                Keywords: dexmedetomidine, caesarean section, spinal anaesthesia, meta-analysis

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