Effect of Intraperitoneal Instillation of Dexmedetomidine With Local Anesthetics in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Trials.

Chenxu Sun, Zhengguang He, Biao Feng, Yaping Huang, Dawei Liu, Zhihua Sun
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Abstract

Objective: Dexmedetomidine (DEX) can strengthen the analgesic effects of local anesthetics (LAs) when used as an adjuvant through intrathecal, perineural, and intraperitoneal routes. Many studies have used intraperitoneal instillation of DEX with LAs in laparoscopic cholecystectomy (LC) to relieve postoperative pain. We performed a systematic review and meta-analysis to synthesize evidence of the efficacy and safety of intraperitoneal instillation of DEX as an adjuvant of LAs in patients undergoing LC.

Methods: A comprehensive literature search of the MEDLINE, PubMed, EMBASE, and Cochrane Library databases was performed to identify randomized controlled trials in which patients received intraperitoneal instillation of DEX combined with LAs during LC. A meta-analysis and sensitivity analysis of the results were conducted. We also performed a subgroup analysis to investigate the source of heterogeneity. The Egger test was used to check for publication bias.

Results: Eleven randomized controlled trials involving 890 patients were analyzed. We found that the addition of DEX to LAs significantly decreased pain scores at six postoperative time points (0.5, 1, 2, 4, 12, and 24 h) and significantly prolonged the time to the first analgesic request by patients. In addition, 24-hour postoperative analgesic consumption was decreased in the experimental group, and no significant difference in the incidence of nausea and vomiting was observed.

Conclusion: Our findings indicate that intraperitoneal instillation of DEX with LAs can reduce postoperative pain and prolong the time to first request analgesia after LC.

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腹腔镜胆囊切除术中右美托咪定与局部麻醉剂腹腔内灌注的效果:随机试验的系统回顾和元分析》。
目的:右美托咪定(DEX右美托咪定(DEX)作为局麻药(LAs)的辅助药物,通过鞘内、硬膜外和腹膜内途径使用时,可加强局麻药的镇痛效果。许多研究在腹腔镜胆囊切除术(LC)中使用腹腔灌注 DEX 和 LAs 来缓解术后疼痛。我们进行了一项系统性回顾和荟萃分析,以综合腹腔内灌注DEX作为LAs在LC患者中辅助治疗的有效性和安全性的证据:方法:对 MEDLINE、PubMed、EMBASE 和 Cochrane Library 数据库进行了全面的文献检索,以确定在 LC 期间患者接受腹腔灌注 DEX 和 LAs 的随机对照试验。我们对结果进行了荟萃分析和敏感性分析。我们还进行了亚组分析,以研究异质性的来源。采用Egger检验检查发表偏倚:结果:我们对涉及 890 名患者的 11 项随机对照试验进行了分析。我们发现,在 LAs 中添加 DEX 可显著降低术后六个时间点(0.5、1、2、4、12 和 24 h)的疼痛评分,并显著延长患者首次要求镇痛药的时间。此外,实验组术后 24 小时的镇痛药用量减少,恶心和呕吐的发生率无明显差异:我们的研究结果表明,腹腔注射DEX和LAs可以减轻术后疼痛,延长LC术后首次要求镇痛的时间。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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