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Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials.

AbstractBACKGROUND:
Aim of the current meta-analysis was to assess the effects of intraoperative dexmedetomidine on postoperative pain, analgesic consumption, and adverse events in comparison with placebo or opioids in children undergoing surgery.
METHODS:
This meta-analysis was performed according to the recommendations of the PRISMA statement and the Cochrane collaboration. For dichotomous and continuous outcomes of efficacy and adverse events, the Revman(®) (The Nordic Cochrane Centre, Copenhagen, Denmark) statistical software was used to calculate relative risk (RR), mean difference (MD), and 95% confidence intervals (CI).
RESULTS:
We included 11 randomized controlled trials - 434 children received dexmedetomidine, 440 received control. In comparison with placebo, children receiving dexmedetomidine showed a reduced RR for postoperative opioids (0.4; 95% CI: 0.26-0.62; P < 0.00001) and postoperative pain (0.51; 95% CI: 0.32-0.81; P = 0.004). Similar results were obtained for the comparison with intraoperative opioids: reduced RR for postoperative pain (0.49; 95% CI: 0.25-0.94; P = 0.03) and the need for postoperative opioids (0.77; 95% CI: 0.60-1.09; P = 0.05).
CONCLUSIONS:
This meta-analysis revealed a lower risk for postoperative pain and the need for postoperative opioids following intraoperative dexmedetomidine in comparison with placebo or opioids in children undergoing surgery; however, the influence of dexmedetomidine on postoperative opioid consumption is less clear. Although there were only a limited number of adverse events, further studies focusing on procedure specific dexmedetomidine dosing and adverse events are urgently needed.
AuthorsAlexander Schnabel, Sylvia U Reichl, Daniel M Poepping, Peter Kranke, Esther M Pogatzki-Zahn, Peter K Zahn
JournalPaediatric anaesthesia (Paediatr Anaesth) Vol. 23 Issue 2 Pg. 170-9 (Feb 2013) ISSN: 1460-9592 [Electronic] France
PMID23043461 (Publication Type: Journal Article, Meta-Analysis, Review)
Copyright© 2012 Blackwell Publishing Ltd.
Chemical References
  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Dexmedetomidine
Topics
  • Airway Extubation
  • Analgesics, Non-Narcotic (adverse effects, therapeutic use)
  • Analgesics, Opioid (administration & dosage, therapeutic use)
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Critical Care
  • Dexmedetomidine (adverse effects, therapeutic use)
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay
  • Pain, Postoperative (drug therapy)
  • Psychomotor Agitation (epidemiology)
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Treatment Outcome

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