Table 1 Articles included in the review analyzing the use of dexmedetomidine in periarticular infiltrations
From: Periarticular infiltration used in total joint replacements: an update and review article
Name | Type of study | Number of patients | Groups and findings | Dosage of DM | Duration of DM | Main findings | Complications (postop delirium, Nausea, Hypotension, Bradycardia | Exclusion criteria |
|---|---|---|---|---|---|---|---|---|
Zhao et al. [2] | RCT | 116 total knee arthroplasty patients | Control (Ropivicaine) (1) Epinephrine + Ropivicaine (2) Dexmedetomidine + Ropivicaine(3) DM had lower pain scores at 6 h DM + Epinephrine had lower pain scores for first 24 h | 2.0 ug/kg | Good pain relief 6–12 h after surgery | Lower levels of proinflammatory cytokines. Prolong sensory block and minimize motor block effect | No complications | Allergies to the medications; severe knee deformities;history of a knee infection;Long-term opioid usage; history of neuromuscular disorders;diagnosis of severe cardiovascular disease |
Nickar et al. [3] | RCT | 75 total knee arthroplasty patients | DM + Ropivicaine(1) Ketorolac + Ropivicaine (2) Control (Ropivicaine) (3) | 1.0 ug/kg | 150 min  ±  54.22 pain relief | Ketorolac demonstrated better pain relief compared to DM | No complications | Patients with a history of infection or malignant disease; cardiac disease(receiving Beta-Blockers, calcium channel blockers or alpha-methyldopa, coagulopathy, hepatic or kidney disease, allergic reaction to medications |
Salem et al. [4] | RCT | 45 knee arthroscopy patients | Control (1) DM (2) Fentanyl (3) | 100 ug | 505 min pain relief | Fentanyl had the longest pain relief (693 min) First 6 h had same pain relief between Fentanyl + DM | No complications | Advanced renal or hepatic disease;psychiatric disorders;prolonged intake of NSAIDS, patients taking beta-blockers-tricyclic antidepressants; allergic reactions to medications |
Pangrahi et al. [5] | RCT | 60 arthroscopy patients | (1) Control (2) DM (1 ug/kg) (3) DM (2 ug/kg) | 1–2 ug/kg | 757.3  ± 207.68 min in group 3 | Group 3 demonstrated significant lower pain scores in first 12 h, lower analgesic requirement and lower intensity of pain | No complications | Allergy to medications;pregnancy or lactation;hepatic-renal-cardiopulmonary abnormality; alcoholism,diabetes,bleeding diathesis,patients of Beta-blockers,clonidine,alpha-methyldopa; patients using opioid or non-opioid analgesia |
Mohamed et al. [6] | RCT | 90 abdominal hysterectomy patients | (1) Bupivicaine 0.25% + 2 mg/kg Ketamine (2) Bupivicaine 0.25% + DM 2 ug/kg | 2 ug/kg | (1) Ketamine – 7.6 ±  4.16 h (2) DM – 6.00  ± 3.73 h | Rescue analgesia, first dose of analgesia, VAS score was less in Ketamine + DM group with Ketamine doing slightly better than DM | 6.7% of patients had sedation + hypotension in DM group | Significant cardiac,respiratory,renal or hepatic diseases, coagulation disorders, patients with infection, patients with psychiatric illnesses |
Hao et al. [7] | RCT | 120 patients undergoing tonsillectomies or adenoinectomies | (1) GA + Ropivicaine + DM (2) GA + Ropivicaine | 1 ug/kg | 10 h (9.4–11.4) | Pain scores were significantly lower at the 8th,16th,20th and 24th hour after surgery | None documented | Patients with cardiovascular,respiratory and endocrine disorders; Patients with known allergies to local anesthetics |
Azemati et al. [8] | RCT | 60 pediatric patients undergoing unilateral herniorraphy | (1) Bupivicaine 0.5% + DM (2) Bupivicaine 0.5% | 1 ug/kg | 2 h | Pain scores were better in the first 2 h for the DM group | Heart rate was statistical lower in the DM group in the first 20 min after injection. Sedation was also significantly more in the DM for the first 3 h | Patients with history of seizures, coagulopathies,sensitivity to DM, congenital heart disease, history of bleeding disorders, liver or kidney failure, neurological diseases |
Abo Elfadl et al. [9] | RCT | 90 children undergoing tonsillectomies | (1) Levobupivicaine 0.25% + DM (2) Levobupivicaine 0.25% | 1 ug/kg | 644.31 ± 112.89 min | The DM group consumed less analgesia in the first 24 h and had a higher total oral intake | No side effects | Obstructive sleep apnea syndrome;cardiovascular,liver,renal disease,coagulation disorders,relevant drug allergies,neurological or psychiatric illness |
Mitra et al. [10] | RCT | 45 undergoing elective lumbar discectomies | (1) Ropivicaine 0.5% (2) Ropivicaine 0.5% + Tramadol (3) Ropivicaine 0.5% + DM | 0.5 ug/kg | 930 min (854.3–1005.7) | DM group demonstrated statistical longer time to rescue analgesia. Pain scores and Diclofenac consumption in the first 24 h was statistically lower in the DM | No side effects | ASA grade ¾;History of allergy to relevant drugs;patients with severe systemic disease,pregnancy,psychiatric illness,seizure disorder |
Li et al.[11] | RCT | 57 patients with elective posterior lumbar fusion | (1) Ropivicaine 0.5% (2) Ropivicaine 0.5% + DM | 1 ug/kg | 10.5  ± 3.7 h | Significantly less Morphine + PCA requirements in the DM. Analgesic request was delayed and Vas core reduced up to 16 h after surgery | No side effects | Allergies to relevant medications; long-term treatment with opioids;renal or hepatic insufficiency;neoplastic disorders;BMI >  = 30, local sepsis;unbalanced cardiopathy or pneumopathy, severe diabetes;preoperative psychiatric or cognitive disorders,coagulation abnormalities |
Yu et al. [12] | RCT | 140 patients undergoing laparoscopic cholecystectomy | (1) Placebo group (saline) (2) Ropivacaine 0.5%(skin); + Saline(deltoid muscle) (3) ropivacaine 0.5% + DM (Skin); and Saline at the deltoid muscle (4) Ropivicaine 0.5% (skin); and DM at the deltoid muscle | 1 ug/kg | 12 h | DM did demonstrate lower Vas score scores compared to Ropivicaine + saline up to 12 h. The Ropivicaine + DM combined at the sking performed the best | No adverse events. Slight decrease in diastolic + systolic blood Pressure in DM groups (no statistical significant) | BMI >  = 30; renal or hepatic disorders, opioid usage;history of alcohol or drug abuse;ASA status or 3 or greater;contraindications of use(hypotension or bradycardia);pregnancy, patients with history of chronic pain; allergic to relevant medications |
Luan et al. [13] | RCT | 50 patients undergoing an open gastrectomy | (1) Ropivicaine 0.3% (2) Ropivicaine 0.3% + DM | 1 ug/kg | Didn’t record first time to analgesia | No difference in VAS scores between groups. Higher Sufentanil consumption in the first 24 h | No adverse events | Allergy to relevant medications; BMI >  = 30; opioids addiction; chronic pain, psychiatric diseases |