Efficacy of dexmedetomidine for pain management in knee arthroscopy: A systematic review and meta-analysis

Chen Li, Ji Qu, Chen Li, Ji Qu

Abstract

Background: Dexmedetomidine showed some potential in pain control in patients undergoing knee arthroscopy. We conducted a systematic review and meta-analysis to explore the efficacy of dexmedetomidine in patients undergoing knee arthroscopy.

Methods: We searched the randomized controlled trials (RCTs) assessing the effect of dexmedetomidine on knee arthroscopy in PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. The primary outcome was pain scores. Meta-analysis was performed using the random-effect model.

Results: Five RCTs were included. Overall, compared with control intervention in patients with knee arthroscopy, dexmedetomidine intervention could significantly reduce the pain scores [Std. mean difference = -0.84; 95% confidence interval (95% CI) = -1.24 to -0.44; P < .0001] and postoperative diclofenac sodium consumption (Std. mean difference = -1.76; 95% CI = -3.32 to -0.21; P = .03), improve duration of analgesic effect (Std. mean difference = 1.78; 95% CI = 0.56-3.00; P = .004), but showed no influence on hypotension [risk ratio (RR) = 0.93; 95% CI = 0.14-5.92; P = .94], bradycardia (RR = 4.93; 95% CI = 0.91-26.58; P = .06), nausea, and vomiting (RR = 1.96; 95% CI = 0.31-12.58; P = .48).

Conclusion: Dexmedetomidine intervention was able to significantly reduce the pain scores and postoperative diclofenac sodium consumption, and improve duration of analgesic effect in patients undergoing knee arthroscopy, but had no influence on hypotension, bradycardia, nausea, and vomiting.

Conflict of interest statement

The authors declared no conflict of interest. And no funding was provided for this study. Research did not involve human participants and/or animals.

Figures

Figure 1
Figure 1
Flow diagram of study searching and selection process.
Figure 2
Figure 2
Forest plot for the meta-analysis of pain score.
Figure 3
Figure 3
Forest plot for the meta-analysis of postoperative diclofenac sodium consumption (mg).
Figure 4
Figure 4
Forest plot for the meta-analysis of duration of analgesic effect (min).
Figure 5
Figure 5
Forest plot for the meta-analysis of hypotension.
Figure 6
Figure 6
Forest plot for the meta-analysis of bradycardia.
Figure 7
Figure 7
Forest plot for the meta-analysis of nausea and vomiting.

References

    1. Pihl K, Englund M, Lohmander LS, et al. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear. Acta Orthop 2017;88:90–5.
    1. Lohmander LS, Thorlund JB, Roos EM. Routine knee arthroscopic surgery for the painful knee in middle-aged and old patients: time to abandon ship. Acta Orthop 2016;87:2–4.
    1. Dogan N, Erdem AF, Erman Z, Kizilkaya M. The effects of bupivacaine and neostigmine on articular cartilage and synovium in the rabbit knee joint. J Int Med Res 2004;32:513–9.
    1. Monk P, Garfjeld Roberts P, Palmer AJ, et al. The urgent need for evidence in arthroscopic meniscal surgery. Am J Sports Med 2017;45:965–73.
    1. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 2015;350:h2747.
    1. Imani F, Entezary S, Razi M, et al. The effect of intra-articular meperidine and bupivacaine 0.5% on postoperative pain of arthroscopic knee surgery; a randomized double blind clinical trial. Anesthesiol Pain Med 2015;5:e27470.
    1. Sun QB, Liu SD, Meng QJ, et al. Single administration of intra-articular bupivacaine in arthroscopic knee surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2015;16:21.
    1. Antoni M, Jenny JY, Noll E. Postoperative pain control by intra-articular local anesthesia versus femoral nerve block following total knee arthroplasty: impact on discharge. Orthop Traumatol Surg Res 2014;100:313–6.
    1. Gupta B, Banerjee S, Prasad A, et al. Analgesic efficacy of three different dosages of intra-articular morphine in arthroscopic knee surgeries: randomised double-blind trial. Indian J Anaesth 2015;59:642–7.
    1. Stein C, Comisel K, Haimerl E, et al. Analgesic effect of intraarticular morphine after arthroscopic knee surgery. N Engl J Med 1991;325:1123–6.
    1. Yang Y, Zeng C, Wei J, et al. Single-dose intra-articular bupivacaine plus morphine versus bupivacaine alone after arthroscopic knee surgery: a meta-analysis of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2017;25:966–79.
    1. Wei J, Lei GH, Gao SG, et al. Single-dose intra-articular bupivacaine versus morphine after arthroscopic knee surgery: a meta-analysis of randomized-controlled studies. Clin J Pain 2014;30:630–8.
    1. Gerlach AT, Dasta JF. Dexmedetomidine: an updated review. Ann Pharmacother 2007;41:245–52.
    1. Zhang C, Li C, Pirrone M, et al. Comparison of dexmedetomidine and clonidine as adjuvants to local anesthetics for intrathecal anesthesia: a meta-analysis of randomized controlled trials. J Clin Pharmacol 2016;56:827–34.
    1. Poorzamany Nejat Kermany M, Dahi M, Yamini Sharif R, Radpay B. Comparison of the effects of dexmedetomidine and remifentanil on cognition state after cataract surgery. Anesthesiol Pain Med 2016;6:e33448.
    1. Bilgi KV, Vasudevan A, Bidkar PU. Comparison of dexmedetomidine with fentanyl for maintenance of intraoperative hemodynamics in hypertensive patients undergoing major surgery: a randomized controlled trial. Anesth Essays Res 2016;10:332–7.
    1. Gomez-Vazquez ME, Hernandez-Salazar E, Hernandez-Jimenez A, et al. Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery. J Clin Anesth 2007;19:576–82.
    1. Alipour M, Tabari M, Faz RF, et al. Effect of dexmedetomidine on postoperative pain in knee arthroscopic surgery; a randomized controlled clinical trial. Arch Bone Joint Surg 2014;2:52–6.
    1. Paul S, Bhattacharjee DP, Ghosh S, et al. Efficacy of intra-articular dexmedetomidine for postoperative analgesia in arthroscopic knee surgery. Ceylon Med J 2010;55:111–5.
    1. Panigrahi R, Roy R, Mahapatra AK, et al. Intra-articular adjuvant analgesics following knee arthroscopy: comparison between single and double dose dexmedetomidine and ropivacaine a multicenter prospective double-blind trial. Orthop Surg 2015;7:250–5.
    1. Karaaslan D, Peker TT, Alaca A, et al. Comparison of buccal and intramuscular dexmedetomidine premedication for arthroscopic knee surgery. J Clin Anesth 2006;18:589–93.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.
    1. Higgins JPT GS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available at: Accessed March 21, 2011.
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–2.
    1. Kjaergard LL, Villumsen J, Gluud C. Reported methodologic quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med 2001;135:982–9.
    1. Whitford A, Healy M, Joshi GP, et al. The effect of tourniquet release time on the analgesic efficacy of intraarticular morphine after arthroscopic knee surgery. Anesth Analg 1997;84:791–3.

Source: PubMed

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