The efficacy of buprenorphine compared with dexmedetomidine in spinal anesthesia: a systematic review and meta-analysis
Eficácia da buprenorfina em comparação com a dexmedetomidina na raquianestesia: uma revisão sistemática e meta-análise
Joao Marcos Cansian, Angelo Zanin D'Angelo Giampaoli, Liege Caroline Immich, Andre Prato Schmidt, Andrei Sanson Dias
Abstract
Background
This study compares dexmedetomidine and buprenorphine as potential adjuvants for spinal anesthesia. Dexmedetomidine enhances sensory block and minimizes the need for pain medication, while buprenorphine, a long-acting opioid, exhibits a favorable safety profile compared to traditional opioids.
Methods
PubMed, Cochrane and EMBASE were systematically searched in December 2023. Eligibility criteria: RCTs with patients scheduled for lower abdominal, pelvic, or lower limb surgeries; undergoing spinal anesthesia with a local anesthetic and buprenorphine or dexmedetomidine.
Results
Eight RCTs involving 604 patients were included. Compared with dexmedetomidine, buprenorphine significantly reduced time for sensory regression to S1 (Risk Ratio [RR = -131.28]; 95% CI -187.47 to -75.08; I2 = 99%) and motor block duration (RR = -118.58; 95% CI -170.08 to -67.09; I2 = 99%). Moreover, buprenorphine increased the onset time of sensory block (RR = 0.42; 95% CI 0.03 to 0.81; I2 = 93%) and increased the incidence of postoperative nausea and vomiting (RR = 4.06; 95% CI 1.80 to 9.18; I² = 0%). No significant differences were observed in the duration of analgesia, onset time of motor block, time to achieve the highest sensory level, shivering, hypotension, or bradycardia.
Conclusions
The intrathecal administration of buprenorphine, when compared to dexmedetomidine, is linked to reduction in the duration of both sensory and motor blocks following spinal anesthesia. Conversely, buprenorphine was associated with an increased risk of postoperative nausea and vomiting and a longer onset time of sensory block. Further high-quality RCTs are essential for a comprehensive understanding of buprenorphine's effects compared with dexmedetomidine in spinal anesthesia.
Keywords
Resumo
Introdução
Este estudo compara dexmedetomidina e buprenorfina como adjuvantes potenciais para anestesia espinhal. A dexmedetomidina aumenta o bloqueio sensorial e minimiza a necessidade de medicação para dor, enquanto a buprenorfina, um opioide de ação prolongada, exibe um perfil de segurança favorável em comparação aos opioides tradicionais.
Métodos
PubMed, Cochrane e EMBASE foram sistematicamente pesquisados em dezembro de 2023. Critérios de elegibilidade: ECRs com pacientes agendados para cirurgias abdominais inferiores, pélvicas ou de membros inferiores; submetidos à anestesia espinhal com anestésico local e buprenorfina ou dexmedetomidina.
Resultados
Oito ECRs envolvendo 604 pacientes foram incluídos. Comparado com a dexmedetomidina, a buprenorfina reduziu significativamente o tempo para regressão sensorial para S1 (razão de risco [RR = -131,28]; IC de 95% -187,47 a -75,08; I2 = 99%) e a duração do bloqueio motor (RR = -118,58; IC de 95% -170,08 a -67,09; I2 = 99%). Além disso, a buprenorfina aumentou o tempo de início do bloqueio sensorial (RR = 0,42; IC de 95% 0,03 a 0,81; I2 = 93%) e aumentou a incidência de náusea e vômito pós-operatórios (RR = 4,06; IC de 95% 1,80 a 9,18; I² = 0%). Não foram observadas diferenças significativas na duração da analgesia, tempo de início do bloqueio motor, tempo para atingir o nível sensorial mais alto, tremores, hipotensão ou bradicardia.
Conclusões
A administração intratecal de buprenorfina, quando comparada à dexmedetomidina, está relacionada à redução na duração dos bloqueios sensoriais e motores após a raquianestesia. Por outro lado, a buprenorfina foi associada a um risco aumentado de náusea e vômito pós-operatórios e a um tempo de início mais longo do bloqueio sensorial. Mais RCTs de alta qualidade são essenciais para uma compreensão abrangente dos efeitos da buprenorfina em comparação à dexmedetomidina na raquianestesia.
Palavras-chave
Referências
1. Dillane D, Finucane BT. Local anesthetic systemic toxicity. Can J Anaesth J Can Anesth. 2010;57:368−80.
2. Kosel J, Bobik P, Tomczyk M. Buprenorphine−the unique opioid adjuvant in regional anesthesia. Expert Rev Clin Pharmacol. 2016;9:375−83.
3. DrD T, DrB Gc, DrR R. Comparison of dexmedetomidine v/s buprenorphine as an adjuvant to levobupivacaine in spinal anesthesia for infraumbilical surgeries. Int J Med Anesthesiol. 2018;1:37−41.
4. Mugabure Bujedo B. A clinical approach to neuraxial morphine for the treatment of postoperative pain. Pain Res Treat. 2012;2012:612145.
5. Leffler A, Frank G, Kistner K, et al. Local anesthetic-like inhibition of voltage-gated Na(+) channels by the partial m-opioid receptor agonist buprenorphine. Anesthesiology. 2012;116:1335−46.
6. Takahashi T, Okubo K, Kojima S, et al. Antihyperalgesic effect of buprenorphine involves nociceptin/orphanin FQ peptide-receptor activation in rats with spinal nerve injury-induced neuropathy. J Pharmacol Sci. 2013;122:51−4.
7. Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases. 2017;5:307−23.
8. Hermanns H, Bos EME, van Zuylen ML, Hollmann MW, Stevens MF. The Options for Neuraxial Drug Administration. CNS Drugs. 2022;36:877−96.
9. Moher D, Liberati A, Tetzlaff J, Altman DG, Group PRISMA. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
10. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023) [Internet]. [cited 2024 Apr 25]. Available from: https://training.cochrane.org/handbook.
11. Kaur N, Goneppanavar U, Venkateswaran R, Iyer SS. Comparative Effects of Buprenorphine and Dexmedetomidine as Adjuvants to Bupivacaine Spinal Anaesthesia in Elderly Male Patients Undergoing Transurethral Resection of Prostrate: A Randomized Prospective Study. Anesth Essays Res. 2017;11:886−91.
12. Gupta M, Shailaja S, Hegde KS. Comparison of Intrathecal Dexmedetomidine with Buprenorphine as Adjuvant to Bupivacaine in Spinal Asnaesthesia. J Clin Diagn Res JCDR. 2014;8:114−7.
13. Akhila S, Manjunath AC, Nagaraj MC. A Comparative Study of Intrathecal Dexmedetomidine and Buprenorphine as Adjuvants to Hyperbaric Bupivacaine for Infraumbilical Surgeries. Indian J Anaesth Analg. 2017;4:457−61.
14. DrI Bansal, DrJ Kaur, Goyal A. Comparison of Dexmedetomidine Vs Buprenorphine as Adjuvants to Intrathecal Bupivacaine for Bilateral Total Knee Replacement Surgeries - Randomised Controlled Trail. Sch J Appl Med Sci. 2022;10:1547−52.
15. Gitte Santosh, Patange Vivek A, Agale Sangita. Comparative study of analgesic efficacy, hemodynamic stability, and adverse effects of injection Buprenorphine versus Dexmedetomidine as adjuvant with 0.5% hyperbaric bupivacaine in patients undergoing moderate duration surgeries. Eur J Mol Clin Med. 2022;9(7).
16. Gowrilakshmi E, Vijay A, Sundari B, Jothi N. A comparative study of dexmedetomidine and buprenorphine as an adjuvant with ropivacaine for spinal anesthesia in infra-umbilical surgeries. Int J Acad Med Pharm. 2023;5:2088−93.
17. S A, R P. Comparison of dexmedetomidine and buprenorphine as an adjuvant to bupivacaine during spinal anaesthesia for tibial interlocking nailing surgeries. Int J Adv Med. 2017;4:1653−7.
18. Davis MP. Twelve reasons for considering buprenorphine as a frontline analgesic in the management of pain. J Support Oncol. 2012;10:209−19.
19. Robinson SE. Buprenorphine: an analgesic with an expanding role in the treatment of opioid addiction. CNS Drug Rev. 2002;8:377−90.
20. Lutfy K, Cowan A. Buprenorphine: a unique drug with complex pharmacology. Curr Neuropharmacol. 2004;2:395−402.
21. Shah A, Patel I, Gandhi R. Haemodynamic effects of intrathecal dexmedetomidine added to ropivacaine intraoperatively and for postoperative analgesia. Int J Basic Clin Pharmacol. 2013;2:26−9.
22. White LD, Hodge A, Vlok R, Hurtado G, Eastern K, Melhuish TM. Efficacy and adverse effects of buprenorphine in acute pain management: systematic review and meta-analysis of randomised controlled trials. Br J Anaesth. 2018;120:668−78.
23. Feenstra ML, Jansen S, Eshuis WJ, van Berge Henegouwen MI, Hollmann MW, Hermanides J. Opioid-free anesthesia: A systematic review and meta-analysis. J Clin Anesth. 2023;90:111215
24. Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005;101:1343−8.
25. Liu S, Zhao P, Cui Y, et al. Effect of 5-mg Dose of Dexmedetomidine in Combination with Intrathecal Bupivacaine on Spinal Anesthesia: A Systematic Review and Meta-analysis. Clin Ther. 2020;42:676−90. e5.
26. Zhang Y, Shan Z, Kuang L, et al. The effect of different doses of intrathecal dexmedetomidine on spinal anesthesia: a metaanalysis. Int J Clin Exp Med. 2016;9:18860−7.
27. Al-Mustafa MM, Abu-Halaweh SA, Aloweidi AS, et al. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Saudi Med J. 2009;30:365−70.
28. Niu XY, Ding XB, Guo T, Chen MH, Fu SK, Li Q. Effects of intravenous and intrathecal dexmedetomidine in spinal anesthesia: a meta-analysis. CNS Neurosci Ther. 2013;19:897−904.
29. Comparative study of analgesic efficacy, hemodynamic stability, and adverse effects of injection Buprenorphine versus Dexmedetomidine as adjuvant with 0.5% hyperbaric bupivacaine in patients undergoing moderate duration surgeries | Cochrane Library [Internet]. [cited 2024 Apr 25]. Available from: https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02515607/full.
30. Mahendru V, Tewari A, Katyal S, Grewal A, Singh MR, Katyal R. A comparison of intrathecal dexmedetomidine, clonidine, and fentanyl as adjuvants to hyperbaric bupivacaine for lower limb surgery: A double blind controlled study. J Anaesthesiol Clin Pharmacol. 2013;29:496−502.
Submetido em:
14/04/2024
Aceito em:
27/07/2024
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