Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2022.07.005
Brazilian Journal of Anesthesiology
Systematic Review

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials

Dexmedetomidina versus clonidina como adjuvante do anestésico local em bloqueios do plexo braquial: metanálise de ensaios clínicos randomizados

Vijeta Bajpai, Tejas K. Patel, Priyanka Dwivedi, Amrita Bajpai, Astha Gupta, Pradeepika Gangwar, Yashpal Singh, Richa Agarwal, Surekha Kishore

http://dx.doi.org/10.1016/j.bjane.2022.07.005 Braz J Anesthesiol, vol.73, n5, p.665-675, 2022
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Abstract

Objective

This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs.

Methods

Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach.

Results

Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02‒208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55‒185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25‒238.58; I2 = 99%; GRADE approach evidence- high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60‒2.41; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63‒10.66; I2 = %).

Conclusion

Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than clonidine.

Keywords

Dexmedetomidine; Clonidine; Brachial plexus block; Meta-analysis

Resumo

Introdução

Esta meta-análise teve como objetivo comparar a eficácia e segurança da dexmedetomidina e da clonidina como adjuvante dos anestésicos locais em BPBs.

Métodos

Dois investigadores pesquisaram independentemente os bancos de dados para identificar todos os ECRs comparando a eficácia e/ou segurança da dexmedetomidina e da clonidina como adjuvante dos anestésicos locais em BPBs. Todos os resultados foram agrupados usando o método de variância inversa com um modelo de efeito aleatório. Um teste I2 foi utilizado para avaliar a heterogeneidade. A fonte da heterogeneidade foi explorada através de meta-regressão. A qualidade da evidência foi avaliada utilizando a abordagem GRADE.

Resultados

Dos 123 textos completos avaliados, 24 estudos (1.448 pacientes) foram incluídos na análise. Em comparação com a clonidina, os grupos dexmedetomidina apresentaram duração do bloqueio sensorial significativamente mais longa (MD = 173,31; IC 95% 138,02-208,59; I2 = 99%; evidência da abordagem GRADE: alta); duração do bloqueio motor (MD = 158,35; IC 95% 131,55‒185,16; I2 = 98%; evidência da abordagem GRADE: alta), duração da analgesia (MD = 203,92; IC 95% 169,25‒238,58; I2 = 99%; evidência da abordagem GRADE - alto) e proporcionou maior qualidade de bloqueio (RR = 1,97; IC 95% 1,60-2,41; I2 = 0%; evidência da abordagem GRADE: moderada). A técnica de posicionamento do bloco (coeficiente de regressão: 51,45, p = 0,005) foi observada como um preditor significativo da heterogeneidade no caso da duração do bloqueio sensorial. Não foi observada diferença significativa para o risco de hipotensão (RR = 2,59; IC 95% 0,63‒10,66; I2 = %).

Conclusão

Evidências de moderada a alta qualidade sugerem que a dexmedetomidina é um adjuvante mais eficaz ao anestésico local em BPBs do que a clonidina.

Palavras-chave

Dexmedetomidina; Clonidina; Bloqueio do plexo braquial; Meta-análise

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Submitted date:
01/03/2022

Accepted date:
07/18/2022

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