Abstract：
OBJECTIVE: This systematic review and meta-analysis aims to assess the efficacy and safety of dexmedetomidine as an adjuvant to intra-articular (IA) injections of local anesthetics (LA) in adult patients undergoing knee arthroscopy.
METHODS: We searched MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing IA dexmedetomidine plus LA versus LA alone for knee arthroscopy in adults. We used the DerSimonian and Laird random-effects model for all outcomes, and conducted a sensitivity analysis with the leave-one-out method, as well as a subgroup analysis for the type of LA. We used R version 4.1.2 for all statistical analyses.
RESULTS: We included 16 RCT encompassing 799 patients, of whom 49.8% received IA dexmedetomidine. In the pooled analysis, time to first analgesia rescue was prolonged in almost 4 hours with the use of dexmedetomidine (MD 229 min; p<0.001). We found statistically significant differences favoring dexmedetomidine in pain scores at rest and movement throughout the first 2, 6, 12 and 24 hours postoperatively (p<0.001). Although the mean difference (MD) ranged from -0.3 to -0.9 cm, corresponding to a 3 to 9% reduction in pain scores, this change is not clinically significant when compared to the minimal clinically important difference (MCID). Additionally, the intervention group showed a statistically significant reduction in cumulative opioid consumption over 24 hours (MD -4.5 mg; p<0.001). However, this reduction did not meet the threshold for the MCID. There was no difference between groups on the incidence of hypotension (p=0.190), bradycardia (p=0.430) and postoperative nausea and vomiting (p=0.550).
CONCLUSIONS: Adding dexmedetomidine to LA in IA injections for knee arthroscopy significantly extended analgesia duration. Additionally, it lowered pain scores and opioid use, although these effects did not reach the MCID. Furthermore, this addition did not increase the risk of adverse events.
METHODS: We searched MEDLINE, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing IA dexmedetomidine plus LA versus LA alone for knee arthroscopy in adults. We used the DerSimonian and Laird random-effects model for all outcomes, and conducted a sensitivity analysis with the leave-one-out method, as well as a subgroup analysis for the type of LA. We used R version 4.1.2 for all statistical analyses.
RESULTS: We included 16 RCT encompassing 799 patients, of whom 49.8% received IA dexmedetomidine. In the pooled analysis, time to first analgesia rescue was prolonged in almost 4 hours with the use of dexmedetomidine (MD 229 min; p<0.001). We found statistically significant differences favoring dexmedetomidine in pain scores at rest and movement throughout the first 2, 6, 12 and 24 hours postoperatively (p<0.001). Although the mean difference (MD) ranged from -0.3 to -0.9 cm, corresponding to a 3 to 9% reduction in pain scores, this change is not clinically significant when compared to the minimal clinically important difference (MCID). Additionally, the intervention group showed a statistically significant reduction in cumulative opioid consumption over 24 hours (MD -4.5 mg; p<0.001). However, this reduction did not meet the threshold for the MCID. There was no difference between groups on the incidence of hypotension (p=0.190), bradycardia (p=0.430) and postoperative nausea and vomiting (p=0.550).
CONCLUSIONS: Adding dexmedetomidine to LA in IA injections for knee arthroscopy significantly extended analgesia duration. Additionally, it lowered pain scores and opioid use, although these effects did not reach the MCID. Furthermore, this addition did not increase the risk of adverse events.
摘要：
目的：本系统综述和荟萃分析旨在评估右美托咪定作为膝关节镜检查成年患者关节内注射局部麻醉药（LA）的辅助治疗的有效性和安全性。
方法：我们搜索了MEDLINE，Embase,和Cochrane图书馆用于比较右美托咪定联合LA与单独LA用于成人膝关节镜检查的随机对照试验（RCT）。我们对所有结果都使用了DerSimonian和Laird随机效应模型，并用留一法进行了敏感性分析，以及LA类型的亚组分析。我们使用R版本4.1.2进行所有统计分析。
结果：我们纳入了16例RCT，包括799例患者，其中49.8%接受右美托咪定IA.在汇总分析中，使用右美托咪定后,首次镇痛抢救时间在近4小时内延长(MD229min;p<0.001).我们发现，在术后前2、6、12和24小时内，右美托咪定在休息和运动时的疼痛评分方面存在显著差异（p<0.001）。尽管平均差（MD）在-0.3到-0.9厘米之间，对应于疼痛评分降低3％至9％，与最小临床重要差异(MCID)相比,这种变化在临床上并不显著.此外,干预组显示,24小时内累积阿片类药物用量显著减少(MD-4.5mg;p<0.001).然而,这种减少没有达到MCID的阈值.两组在低血压的发生率上没有差异（p=0.190），心动过缓（p=0.430）和术后恶心呕吐（p=0.550）。
结论：在膝关节镜的IA注射中加入右美托咪定可显著延长镇痛持续时间。此外,它降低了疼痛评分和阿片类药物的使用，虽然这些影响没有达到MCID。此外，这一添加并未增加不良事件的风险.
方法：我们搜索了MEDLINE，Embase,和Cochrane图书馆用于比较右美托咪定联合LA与单独LA用于成人膝关节镜检查的随机对照试验（RCT）。我们对所有结果都使用了DerSimonian和Laird随机效应模型，并用留一法进行了敏感性分析，以及LA类型的亚组分析。我们使用R版本4.1.2进行所有统计分析。
结果：我们纳入了16例RCT，包括799例患者，其中49.8%接受右美托咪定IA.在汇总分析中，使用右美托咪定后,首次镇痛抢救时间在近4小时内延长(MD229min;p<0.001).我们发现，在术后前2、6、12和24小时内，右美托咪定在休息和运动时的疼痛评分方面存在显著差异（p<0.001）。尽管平均差（MD）在-0.3到-0.9厘米之间，对应于疼痛评分降低3％至9％，与最小临床重要差异(MCID)相比,这种变化在临床上并不显著.此外,干预组显示,24小时内累积阿片类药物用量显著减少(MD-4.5mg;p<0.001).然而,这种减少没有达到MCID的阈值.两组在低血压的发生率上没有差异（p=0.190），心动过缓（p=0.430）和术后恶心呕吐（p=0.550）。
结论：在膝关节镜的IA注射中加入右美托咪定可显著延长镇痛持续时间。此外,它降低了疼痛评分和阿片类药物的使用，虽然这些影响没有达到MCID。此外，这一添加并未增加不良事件的风险.
