AUTHOR=Li Qian , Yang Yaoxin , Leng Yu , Yin Xiaowei , Liu Jin , Zhou Cheng 

TITLE=Dexmedetomidine with different concentrations added to local anesthetics in erector spinae plane block: a meta-analysis of randomized controlled trials

JOURNAL=Frontiers in Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1326566

DOI=10.3389/fmed.2024.1326566

ISSN=2296-858X

ABSTRACT=Background: As a perineural local anesthetic (LA) adjuvant, dexmedetomidine has been used to facilitate the potency of erector spinal plane block (ESPB). This quantitative review aimed to evaluated whether perineural dexmedetomidine for ESPB can improve the effects of analgesia compared with LA alone. 
Methods: Randomized controlled trials (RCTs) that investigated the addition of dexmedetomidine to LA compared with LA alone in ESPB were included. The pain scores, duration of sensory block, the time to first analgesia requirement, postoperative morphine consumption, rescue analgesia and dexmedetomidine-related side effects were analyzed and combined using random-effects modelling. 
Results: A total of 823 patients were analyzed from thirteen RCTs. Dexmedetomidine was used at the concentration of 0.5 μg/kg in 3 trials and 1 μg/kg in 9 trials, and both in 1 trial. Both concentrations of dexmedetomidine perineurally administrated significantly reduced the rest VAS scores at 12 hours (0.5 μg/kg dexmedetomidine: MD = -0.86; 95% CI: -1.59 to -0.12; P = 0.02; 1 μg/kg dexmedetomidine: MD = -0.49; 95% CI: -0.83 to -0.16; P = 0.004), and 24 hours (0.5 μg/kg dexmedetomidine: MD = -0.43; 95% CI: -0.74 to -0.13; P = 0.005; 1 μg/kg dexmedetomidine: MD = -0.62; 95% CI: -0.84 to -0.41; P < 0.00001), postoperatively. And both concentrations of dexmedetomidine added in LAs improved the dynamic VAS scores at 12 hours (0.5 μg/kg dexmedetomidine: MD = -0.55; 95% CI: -0.95 to -0.15; P = 0.007; 1 μg/kg dexmedetomidine: MD = -0.66; 95% CI: -1.05 to -0.28; P = 0.0006) and 24 hours (0.5 μg/kg dexmedetomidine: MD = -0.52; 95% CI: -0.94 to -0.10; P = 0.01; 1 μg/kg dexmedetomidine: MD = -0.46; 95% CI: -0.75 to -0.16; P = 0.002), postoperatively. Furthermore, perineural dexmedetomidine prolonged the duration of the sensory block and the time to first analgesia requirement, reduced postoperative morphine consumption, lowered the incidence of rescue analgesia and chronic pain. 
Conclusion: The meta-analysis showed that using perineural dexmedetomidine at either 0.5 μg/kg or 1 μg/kg doses in ESPB can effectively and safely enhance pain relief.