Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/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

References

1. Fischer HBJ. Brachial plexus anaesthesia. In principles and practice of regional anaesthesia. London: Churchill Livingstone; 2003. p. 193−204.

2. Damien B, Murhy Collin JL, Cartney Vincent WS. Novel analgesic adjuvants for brachial plexus block: A systemic review. Anesth Analg. 2000;90:1122−8.

3. El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS. Addition of Clonidine or Dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth. 2009;103:268−74.

4. Popping DM, Elia N, Marret E, Wenk M, Tramer MR. Clonidine as  an adjuvant to local anaesthetic for peripheral nerve and plexus blocks: A meta-analysis of randomized trials. Anesthesiology. 2009;111:406−15.

5. Virtanein R, Savola JM, Saanov Nyman L. Characterization of the selectivity, specificity, and potency of dexmedetomidine as an alpha -2 adrenoceptor. Eur J Pharmacol. 1998;150:194.

6. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anaesth Analg. 2010;111:1548−51.

7. Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2013;110:915−25.

8. Schnabel A, Reichl SU, Weibel S, et al. Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis. Eur J Anaesthesiol. 2018;35:745 −58.

9. Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2017;118:167−81.

10. Hussain N, Grzywacz VP, Ferreri CA, et al. Investigating the Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthesia in Brachial Plexus Block: A Systematic Review and Meta-Analysis of 18 Randomized Controlled Trials. Reg Anesth Pain Med. 2017;42:184−96.

11. Dai W, Tang M, He K. The effect and safety of dexmedetomidine added to ropivacaine in brachial plexus block: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97: e12573.

12. Ping Y, Ye Q, Wang W, Ye P, You Z. Dexmedetomidine as an adjuvant to local anesthetics in brachial plexus blocks: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96:e5846.

13. Wang K, Wang LJ, Yang TJ, Mao QX, Wang Z, Chen LY. Dexmedetomidine combined with local anesthetics in thoracic paravertebral block: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97: e13164.

14. El-Boghdadly K, Brull R, Sehmbi H, Abdallah FW. Perineural dexmedetomidine is more effective than clonidine when added to local anesthetic for supraclavicular brachial plexus block: a systematic review and meta-analysis. Anesth Analg. 2017;124:2008−20.

15. Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;28(366): l4898.

16. Memis D, Turan A, Karamanlio ¸ glu B, Pamukcu Z, Kurt I. Adding ¸ dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg. 2004;98:835−40.

17. Fu R, Gartlehner G, Grant M, et al. Conducting quantitative synthesis when comparing medical interventions: ahrq and the effective health care program. 2010 Oct 25. Methods Guide for Effectiveness and Comparative Effectiveness Reviews [Internet]. RockvilleMD: Agency for Healthcare Research and Quality (US); 2008. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK49407/.

18. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924−6.

19. GRADEpro GDT. GRADEpro Guideline Development Tool [Software]. McMaster University; 2020 (developed by Evidence Prime, Inc.). Available from gradepro.org.

20. Bafna U, Sharma G, Sapru S, Khandelwal M, Kothari V, Mathur R. Comparison of clonidine and dexmedetomidine as an adjuvant to 0.5% ropivacaine in supraclavicular brachial plexus block: a prospective, randomized, double-blind and controlled study. J Recent Adv Pain. 2015;1:73−7.

21. Channabasappa SM, Shruthi DK, Shobha MM. A comparative study between dexmedetomidine and clonidine as an adjuvant to ropivacaine in supraclavicular brachial plexus block: a prospective study. J Evolution Med Dent Sci. 2016;5:433−7.

22. Harshavardhana HS. Efficacy of dexmedetomidine compared to clonidine added to ropivacaine in supraclavicular nerve blocks: a prospective, randomized, double blind study. Int J Med Health Sci. 2014;3:127−32.

23. Jinjil K, Bhatnagar V, Swapna P, Tandon U. Comparative evaluation of alpha two agonists dexmedetomidine with clonidine as adjuvants to 0.25% ropivacaine for ultrasound guided supraclavicular block: a randomised double-blind prospective study. Int J Healthc Biomed Res. 2015;3:20−31.

24. Kakad RR, Chaudhari DR, Lawhale SS, Ghodki SG, Bite BM. Comparative study between dexmedetomidine and clonidine as an adjunct to bupivacaine in brachial plexus block in orthopaedic surgeries. J Cont Med A Dent. 2015;3:39−43.

25. Kalyanam P, Julakanti M, Babu BS, Kiran M, Raghuram CG. A prospective randomized study to compare dexmedetomidine with clonidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. J Evol Med Dent Sci. 2015;4:15289−97.

26. Kanvee V, Patel K, Doshi M, Vania M, Gandha K. Comparative study of clonidine and dexmedetomidine as an adjuvant with inj. ropivacaine in supraclavicular brachial plexus block for upper limb surgery. J Res Med Den Sci. 2015;3:127−30.

27. Karthik GS, Sudheer R, Sahajananda H, Rangalakshmi S, Kumar R. Dexmedetomidine and clonidine as adjuvants to levobupivacaine in supraclavicular brachial plexus block: a comparative randomised prospective controlled study. J Evol Med Dent Sci. 2015;4:3207−21.

28. Kataria AP, Jarewal V, Singh G, Attri JP. Comparison of dexmedetomidine and clonidine as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. Int J Med Res Rev. 2017;5:399−404.

29. Kirubahar R, Bose S, Kanna V, Murugadoss K. Comparison of clonidine and dexmedetomidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block for upper limb orthopedic procedures. Int J Res Med Sci. 2016;4:1172−6.

30. Munshi FA, Bano F, Khan AA, Saleem B, Rather MA. Comparison of dexmedetomidine and clonidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block: a randomised double-blind prospective study. J Evol Med Dent Sci. 2015;4:7263−78.

31. Narolia AK, Bhati K, Saini K, Pareek A, Kumari K. To Compare the effect of dexmedetomidine and clonidine as adjuvant to ropivacaine in supraclavicular brachial plexus block for upper limb surgery. IAIM. 2017;4:82−90.

32. Nazir O, Bhat AH, Sharma T, Khatuja A, Misra R. Comparison of clonidine and dexmedetomidine as adjuvants for ropivacaine in supraclavicular brachial plexus block. Sri Lankan J Anaesthesiol. 2019;27:53−8.

33. Palai PK, Soren DK, Panda P, Das SK. A comparative study of clonidine and dexmedetomidine as an adjuvant in supraclavicular brachial plexus block. J Evol Med Dent Sci. 2018;7:1806−10.

34. Rao KG, Kapoor P, Chaurasiya MK, Shukla A. A Randomised double blind prospective study to compare clonidine and dexmedetomidine as an adjuvant in supra-clavicular brachial plexus block. Indian J Fundamental Appl Life Sci. 2014;4:226−9.

35. Reddy MS, Bhaskar KU, Paturu M, Srinivasan KV. A comparative study of the efficacy of dexmedetomidine and clonidine as an adjuvant to bupivacaine in supraclavicular brachial plexus block. Indian J Anesth Analg. 2020;7:562−9.

36. Sebastian D, Ravi M, Dinesh K, Somasekharam P. Comparison of dexmedetomidine and clonidine as adjuvant to ropivacaine in supraclavicular brachial plexus nerve blocks. J Dent Med Sci. 2015;14:91−7.

37. Sharma A, Sharma A, Sharma A, Sood A, Sharma G, Thakur A. Comparison of clonidine with dexmedetomidine as an adjuvant to local anesthetic agent in supraclavicular brachial plexus block. Indian J Anesth Analg. 2019;6:1889−93.

38. Singh R, Singam A. Comparative evaluation of dexmedetomedine versus clonidine as an adjuvant in supraclavicular brachial plexus block. J Krishna Inst Med Sci Univ. 2019;8:2231−4261.

39. sur S Sinha S, Pal S, Chaterjee S, Pahari S. Comparative evaluation of efficacy and duration of analgesia of clonidine and dexmedetomidine as adjuvant to bupivacaine in supraclavicular brachial plexus nerve block in upper limb orthopaedic surgery. Int Res J Nat Appl Sci. 2017;4:231−44.

40. Spurthi George B, Lagoo J. Comparison of low dose dexmedetomidine and clonidine as additives to bupivacaine in ultrasound directed supraclavicular blocks. Indian J Clin Anaesth. 2019;6:134−9.

41. Swami SS, Keniya VM, Ladi SD, Rao R. Comparison of dexmedetomidine and clonidine (a2 agonist drugs) as an adjuvant to local anaesthesia in supraclavicular brachial plexus block: A randomised double-blind prospective study. Indian J Anaesth. 2012;56:243−9.

42. Tandon N, Gupta M, Agrawal J, et al. A comparative clinical study to evaluate the efficacy of levobupivacaine with clonidine and levobupivacaine with dexmedetomidine in supraclavicular brachial plexus block. J Evol Med Dent Sci. 2016;5:925−9.

43. Tripathi A, Sharma K, Somvanshi M, Samal RL. A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol. 2016;32:344−8.

44. Helen L, O'Donnell BD, Moore E. Nerve localization techniques for peripheral nerve block and possible future directions. Acta Anaesthesiol Scand. 2015;59:962−74.

45. Kapral S, Krafft P, Eibenberger K. Ultrasound guided supraclavicular approach for regional anaesthesia of the brachial plexus. Anesth Analg. 1994;78:507−13.

46. Bansal T, Jain M, Singh S. Anatomical variations in brachial plexus on ultrasound: Reason for failure of supraclavicular block ‒ Nerve stimulator along with ultrasound can play a major role for success. J Anaesthesiol Clin Pharmacol. 2019;35:135−6.

47. Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade:failure rate, patient acceptance, and neurologic complications ‒ Study Group on Regional Anaesthesia. Anesth Analg. 1999;88:847−52.

48. Zhang C, Li C, Pirrone M, Sun L, Mi W. 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.

49. Lundblad M, Trifa M, Kaabachi O, et al. Alpha-2 adrenoceptor agonists as adjuncts to peripheral nerve blocks in children: a meta-analysis. Paediatr Anaesth. 2016;26:232−8.

50. Kirksey MA, Haskins SC, Cheng J, Liu SS. Local anesthetic peripheral nerve block adjuvants for prolongation of analgesia: a systematic qualitative review. PLoS One. 2015;10:e0137312.

Submitted date:
01/03/2022

Accepted date:
07/18/2022

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