Overall dexmedetomidine vs. midazolam analysis.

<p>Incidence of EA was similar for the two groups, with no significant difference. However, the requirment of a rescue drug was less in the dexmedetomidine group than in the midazolam group. D, dexmedetomidine; M, midazolam</p

Regional versus systemic dexmedetomidine as an adjuvant to lidocaine for intravenous regional anaesthesia in healthy volunteers: a randomized crossover study

Dexmedetomidine enhances the quality and duration of lidocaine intravenous regional anaesthesia (IVRA). However, the two administration routes have not been directly compared regarding effects on tourniquet tolerance time with lidocaine IVRA. Additionally, it remains unclear whether the prolonged tourniquet tolerance stems from the direct peripheral action of dexmedetomidine or indirect systemic analgesic effects. We conducted forearm IVRA in 12 healthy volunteers using a crossover design on two separate study days. One day, the systemic dexmedetomidine group received an intravenous infusion of 0.5 μg/kg dexmedetomidine (20 mL) in one arm, followed by 0.5% lidocaine (25 mL) forearm IVRA in the contralateral arm. On the other day, the regional dexmedetomidine group received an intravenous 0.9% saline infusion (20 mL) in one arm, followed by combined 0.5% lidocaine (25 mL) and 0.5 μg/kg dexmedetomidine forearm IVRA in the opposite arm. After a two-week washout period, participants crossed over to receive the alternate treatment. The primary outcome was tourniquet tolerance time, from initiating IVRA until the patient-reported tourniquet pain numerical rating scale exceeded three. The tourniquet tolerance time was longer with regional versus systemic dexmedetomidine (36.9 ± 7.6 min vs 23.3 ± 6.2 min, respectively), with a 13.6 min mean difference (95% CI: 10.8 to 16.4 min, p  The addition of regional dexmedetomidine to lidocaine prolonged tourniquet tolerance time in forearm IVRA to a greater extent compared to systemic dexmedetomidine in healthy volunteers. Chinese Clinical Trial Registry, ChiCTR2300067978. The addition of regional dexmedetomidine prolongs tourniquet tolerance time with lidocaine forearm IVRA.Regional dexmedetomidine accelerates sensory block onset time and extends sensory block recovery time when supplemented with lidocaine forearm IVRA.Delayed sedative effects following tourniquet release were witnessed in some participants administered regional dexmedetomidine. The addition of regional dexmedetomidine prolongs tourniquet tolerance time with lidocaine forearm IVRA. Regional dexmedetomidine accelerates sensory block onset time and extends sensory block recovery time when supplemented with lidocaine forearm IVRA. Delayed sedative effects following tourniquet release were witnessed in some participants administered regional dexmedetomidine.</p

Flow diagram of included/excluded studies.

<p>Flow diagram of included/excluded studies.</p

Time to eye-open: dexmedetomidine vs. placebo.

<p>Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine took more time to recover. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo</p

Characteristics of included studies.

<p>Abbreviation: EA, emergence agitation; DEX, dexmedetomidine; NS: normal saline; LMA, laryngeal mask airway; PACU, post anesthesia care unit.</p><p>Characteristics of included studies.</p

Incidence of emergence agitation (EA): dexmedetomidine vs. placebo.

<p>Forest plot shows that the overall effect of pooled trials was in favor of dexmedetomidine. D, dexmedetomidine; P, placebo.</p

Effect of Dexmedetomidine on Preventing Postoperative Agitation in Children: A Meta-Analysis

<div><p>Background</p><p>Emergence agitation (EA) is one of the most common postoperative complications in children. The purpose of this meta-analysis is to assess the effect of dexmedetomidine for preventing postoperative agitation in children.</p><p>Methods</p><p>We searched the Cochrane Central Register of Controlled Trails, MEDLINE, and EMBASE. Randomized controlled trials were included. The following outcome measures were evaluated: incidence of EA, number of patients requiring rescue, time to eye-open, time to extubation, time to discharge from the postanesthesia care unit (PACU).</p><p>Results</p><p>We analyzed 19 trials (1608 patients) that met the inclusion criteria. Compared with placebo, intravenous dexmedetomidine significantly reduced the incidence of EA [risk ratio (RR) 0.34, 95% confidence interval (CI) 0.25–0.44, <i>P</i><0.00001). Dexmedetomidine also decreased the incidence of severe pain (RR 0.41, 95% CI 0.27–0.62, <i>P</i><0.0001) and requirement of a rescue drug (RR 0.31, 95% CI 0.18–0.53, <i>P</i><0.0001). However, compared with placebo, dexmedetomidine increased the time to eye-open by 0.98 min (<i>P</i> = 0.01) and the time to PACU discharge by 4.63 min (<i>P</i> = 0.02). Dexmedetomidine was also compared with midazolam, propofol, ketamine, and fentanyl, among others. No significant difference was found in the incidence of EA for most of these comparisons, with the exception of fentanyl and propofol, where dexmedetomidine was more beneficial.</p><p>Conclusions</p><p>Dexmedetomidine was proved effective for preventing EA and for reducing severe pain and the requirement of rescue drugs. It slightly increased the time to eye-open and the time to PACU discharge. Dexmedetomidine was also more beneficial than propofol or fentanyl in preventing EA.</p></div

Time to discharge from the postanesthesia care unit (PACU): dexmedetomidine vs. placebo.

<p>Forest plot shows that the overall effect of pooled trials was in favor of placebo. Patients given dexmedetomidine stayed longer in the PACU. Heterogeneity was observed when these studies were pooled and the random effects model was chosen for analysis. D, dexmedetomidine; P, placebo</p

Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial

Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection. We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg−1 bolus over 10 min, followed by continuous infusion at 2 mg kg−1 h−1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events. Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1–6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p p p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p p = 0.11). In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract). Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635. Systemic lidocaine failed to clinically improve the overall quality of recovery following laparoscopic colorectal resection.Systemic lidocaine reduced intraoperative remifentanil and time to first flatus but not postoperative 48-h morphine consumption.No differences emerged in patient-reported outcomes like opioid side effects, mobility, or satisfaction between groups postoperatively. Systemic lidocaine failed to clinically improve the overall quality of recovery following laparoscopic colorectal resection. Systemic lidocaine reduced intraoperative remifentanil and time to first flatus but not postoperative 48-h morphine consumption. No differences emerged in patient-reported outcomes like opioid side effects, mobility, or satisfaction between groups postoperatively.</p

Incidence of EA: dexmedetomidine vs. fentanyl.

<p>Forest plot shows that the overall effect of pooled trials without the Pestieau 2011 was in favor of dexmedetomidine. The Pestieau 2011 study was excluded because of clinical and statistical heterogeneity. D, dexmedetomidine; F, fentanyl</p