LAUSR

Background The efficacy and adverse effects of dexmedetomidine (DEX) as a local anaesthetics adjuvant for patient controlled epidural analgesia (PCEA) is inconclusive, and this meta-analysis assesses the efficacy and risks of DEX for PCEA using opioids as a reference. Methods Two researchers independently searched the Pubmed, Embase, Cochrane library, and China Biology Medicine (CBM) for randomized controlled trials comparing DEX and opioids as local anesthetic adjuvants in PCEA. Results A total of 636 patients from seven studies were included in this meta-analysis. The results showed that postoperative patients received DEX graded lower visual analogue scale (VAS) score than patients received opioids in group 4-8h (MD=0.61, 95% confidence interval [Cl] 0.45 to 0.76, P<0.001, I2=0%), group 12h (MD=0.85, 95% Cl 0.61 to 1.09, P<0.001, I2=0%), group 24h (MD=0.59, 95% Cl 0.06 to 1.12, P=0.03, I2=82%) and in group 48h (MD=0.54, 95% Cl 0.05 to 1.02, P=0.03, I2=91%). In addition, DEX is superior to opioids with consideration to lower incidence of itching (OR=2.86, 95% Cl 1.18 to 6.95, P = 0.02, I2=0%), nausea and vomiting (OR=6.83, 95% Cl 3.63 to 12.84, P<0.001, I2=24%). In labor analgesia, showed that DEX in PCEA had no significant difference in neonatal outcomes (PH, PaO2 of cord blood, fetal heart rate) and maternal outcomes (the duration of labor stage, mode of delivery). Conclusions Compared to opioids, DEX as local anesthetics adjuvant in PCEA improved postoperative analgesia, reduced the incidence of itching, nausea and vomiting, and did not increase the incidence of adverse reactions.