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      Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block : Systematic Review and Indirect Meta-analysis

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          Abstract

          Both dexamethasone and dexmedetomidine are effective peripheral nerve block (PNB) perineural adjuncts that prolong block duration. However, each is associated with side effects. With paucity of head-to-head comparisons of these adjuncts, the question of the best adjunct to mix with local anesthetics (LA) for PNB is unanswered. This meta-analysis aims to inform current practice and future research by identifying the superior adjunct by comparing dexamethasone and dexmedetomidine.

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          Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses.

          Fujian Song, Douglas G. Altman, Anne-Marie Glenny … (2003)
          To determine the validity of adjusted indirect comparisons by using data from published meta-analyses of randomised trials. Direct comparison of different interventions in randomised trials and adjusted indirect comparison in which two interventions were compared through their relative effect versus a common comparator. The discrepancy between the direct and adjusted indirect comparison was measured by the difference between the two estimates. Database of abstracts of reviews of effectiveness (1994-8), the Cochrane database of systematic reviews, Medline, and references of retrieved articles. 44 published meta-analyses (from 28 systematic reviews) provided sufficient data. In most cases, results of adjusted indirect comparisons were not significantly different from those of direct comparisons. A significant discrepancy (P<0.05) was observed in three of the 44 comparisons between the direct and the adjusted indirect estimates. There was a moderate agreement between the statistical conclusions from the direct and adjusted indirect comparisons (kappa 0.51). The direction of discrepancy between the two estimates was inconsistent. Adjusted indirect comparisons usually but not always agree with the results of head to head randomised trials. When there is no or insufficient direct evidence from randomised trials, the adjusted indirect comparison may provide useful or supplementary information on the relative efficacy of competing interventions. The validity of the adjusted indirect comparisons depends on the internal validity and similarity of the included trials.
          Article 0 comments Cited 228 times – based on 0 reviews     Review now
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            Bayesian approaches to random-effects meta-analysis: a comparative study.

            Julie A. Thomas, J. Smith, D J Spiegelhalter (1995)
            Current methods for meta-analysis still leave a number of unresolved issues, such as the choice between fixed- and random-effects models, the choice of population distribution in a random-effects analysis, the treatment of small studies and extreme results, and incorporation of study-specific covariates. We describe how a full Bayesian analysis can deal with these and other issues in a natural way, illustrated by a recent published example that displays a number of problems. Such analyses are now generally available using the BUGS implementation of Markov chain Monte Carlo numerical integration techniques. Appropriate proper prior distributions are derived, and sensitivity analysis to a variety of prior assumptions carried out. Current methods are briefly summarized and compared to the full Bayes analysis.
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              Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis.

              F Abdallah, R Brull (2013)
              Nerve blocks improve postoperative analgesia, but their benefits may be short-lived. This quantitative review examines whether perineural dexmedetomidine as a local anaesthetic (LA) adjuvant for neuraxial and peripheral nerve blocks can prolong the duration of analgesia compared with LA alone. All randomized controlled trials (RCTs) comparing the effect of dexmedetomidine as an LA adjuvant to LA alone on neuraxial and peripheral nerve blocks were reviewed. Sensory block duration, motor block duration, block onset times, analgesic consumption, time to first analgesic request, and side-effects were analysed. were combined using random-effects modelling. A total of 516 patients were analysed from nine RCTs. Five trials investigated dexmedetomidine as part of spinal anaesthesia and four as part of a brachial plexus (BP) block. Sensory block duration was prolonged by 150 min [95% confidence interval (CI): 96, 205, P<0.00001] with intrathecal dexmedetomidine. Perineural dexmedetomidine used in BP block may prolong the mean duration of sensory block by 284 min (95% CI: 1, 566, P=0.05), but this difference did not reach statistical significance. Motor block duration and time to first analgesic request were prolonged for both intrathecal and BP block. Dexmedetomidine produced reversible bradycardia in 7% of BP block patients, but no effect on the incidence of hypotension. No patients experienced respiratory depression. Dexmedetomidine is a potential LA adjuvant that can exhibit a facilitatory effect when administered intrathecally as part of spinal anaesthesia or peripherally as part of a BP block. However, there are presently insufficient safety data to support perineural dexmedetomidine use in the clinical setting.
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                Author and article information

                Journal
                Title: Anesthesia & Analgesia
                Abbreviated Title: Anesthesia & Analgesia
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0003-2999
                Publication date Created: 2019
                Publication date (Print): March 2019
                Volume: 128
                Issue: 3
                Pages: 543-554
                Article
                DOI: 10.1213/ANE.0000000000003860
                PubMed ID: 30303864
                SO-VID: ecfada84-87d7-4a3c-88b3-6dc0d568b5b8
                Copyright © © 2019
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