Comparison of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia:a Meta-analysis of randomized controlled trial

摘要

Objective:To systematically review the efficacy of dexmedetomidine and fentanyl as adjuvants for ropivacaine for epidural anesthesia.Methods:We searched the Cochrane Library,PubMed,Embase,CNKI,VIP,WanFang Database,search time from the year of construction to December 2018 for all randomized controlled trials(RCTs)about the efficacy of dexmedetomidine versus fentanyl as adjuvants for ropivacaine for epidural anesthesia.The quality of the studies evaluated by the method recommended by Cochrane Collaboration.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software.Results:Eight RCTs involving 592 Patients were included in our Meta-analysis.The results of meta-analysis showed that compared with fentanyl,dexmedetomidine can reduce the incidence of postoperative nausea and vomiting in patients with ropivacaine epidural anesthesia[OR=0.43,95%CI(0.29,0.66),P<0.0001]and the incidence of post-cold[OR=0.34,95%CI(0.18,0.63),P<0.0001],accelerated onset of analgesia[MD=-2.78,95%CI(-4.81,-0.75),P<0.0001],prolonged time of analgesia[MD=99.04,95%CI(82.73,115.34),P<0.0001],enhanced sedation in non-cesarean section[MD=1.01,95%CI(0.87,1.15),P<0.0001],but increased the incidence of dry mouth[OR=5.63,95%CI(2.85,11.10),P<0.0001],shortening the duration of nerve block[MD=-4.35,95%CI(-7.31,-1.40),P<0.0001],sedation was not as good as fentanyl in cesarean section[MD=-0.89,95%CI(-1.39,-0.38),P<0.0001].Conclusion:Available evidence suggests that dexmedetomidine,as an adjuvant for ropivacaine for epidural anesthesia,has a better analgesic effect than fentanyl,and can reduce the incidence of nausea,vomiting,and chills,but should pay attention to its risk of dry mouth and the sedative effect on different operations.