1
|
Huda AU, Mughal MZ. Adding intrathecal midazolam to local anesthetics improves sensory and motor block and reduces pain score without increasing side effects in lower limb surgeries: A meta-analysis and systematic review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:248-256. [PMID: 38145787 DOI: 10.1016/j.redare.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/31/2023] [Indexed: 12/27/2023]
Abstract
This meta-analysis was done to investigate the role of intrathecal midazolam in lower limb surgeries regarding prolongation of spinal block, postoperative pain control and associated side effects. The included studies reported onset and duration of sensory and motor block, time to first request analgesia, 24h opioid consumption, postoperative pain control, and associated side effects following use of intrathecal midazolam for lower limb surgeries. This review was performed following the PRISMA guidelines and using the online databases, Medline, Science Direct, Google scholar and Cochrane library. We registered this review with the PROSPERO database (ID-CRD42022346361) in August 2022. A total of 10 randomised controlled trials were included in this meta-analysis. Our results showed patients receiving 1mg intrathecal midazolam showed significantly faster onset of sensory block [P=.001 (CI: -0.98, -0.31)]. Duration of sensory and motor block were also significantly prolonged in intrathecal midazolam group [P<.00001 (CI: 18.08, 39.12), P=.002 (CI: 0.45, 2). Intrathecal midazolam also increased the time to first request analgesia [P=.0003, (CI: 1.22, 4.14)]. Pain scores at 4 and 12h postoperatively were significantly lower in patients receiving intrathecal midazolam [P=.00001 (CI: -1.20, -0.47) and P=.05 (CI: -0.52, -0.01) respectively]. In conclusion, the addition of intrathecal midazolam to local anesthetics in lower limb surgeries results in early onset of sensory and motor block. It also increases the duration of sensory and motor block. The time to first request analgesia is increased. VAS pain scores at 4 and 12h postoperatively were also lower without any increased side effects.
Collapse
Affiliation(s)
- A U Huda
- Hamad Medical Corporation, Doha, Qatar.
| | - M Z Mughal
- Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
2
|
Aldosari N, Alrashid S, Alshareeda AH, Alenezi A, Alenezi MY, Almutairi A, Aldweesan Y, Almajed F, Alshakhri A, Alwahhabi F, Almehmadi SA, Albzea W, Alsakka MA, Alhajaji R. Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Cureus 2023; 15:e44132. [PMID: 37641722 PMCID: PMC10460480 DOI: 10.7759/cureus.44132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
Dexmedetomidine has been widely studied in many surgical settings, with possible benefits in lowering anesthetic requirements, improving perioperative hemodynamic stability, and improving postoperative outcomes. This systematic review aims to evaluate the effects of dexmedetomidine in patients undergoing transsphenoidal resection of pituitary adenoma, shedding light on its potential as an adjunctive agent in anesthesia for this specific surgical population. In this review, we searched PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar from inception to July 20, 2023. A total of six randomized clinical trials (RCTs) investigating the effects of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenoma were included in this review. The outcomes of interest were extracted from the included studies as mean difference (MD) and standard deviation (SD), then analyzed using the Review Manager (RevMan, RevMan International Inc., New York, USA) software. Our literature search process retrieved 274 records. Of them, six studies were included in the meta-analysis. There was a significant difference between the dexmedetomidine group compared to the placebo group in terms of heart rate at the end of the surgery (MD = -16.5; CI = [-25.36 to -7.64]; P value = 0.0003) and after extubation (MD = -16.81; CI = [-23.18 to -10.43]; P values < 0.00001). Furthermore, dexmedetomidine significantly reduced the mean arterial blood pressure (MAP) at after both intubation and extubation (MD = -9.11 and -21.5; CI = [-13.56 to -4.65] and [-30.93 to -12.06]; P values < 0.00001). This systematic review and meta-analysis demonstrated that dexmedetomidine appears to have several potential benefits in patients undergoing transsphenoidal resection of pituitary adenoma. The use of dexmedetomidine was associated with reductions in heart rate, mean arterial blood pressure, blood loss, and duration of surgery, while showing no significant difference in propofol dose or time to extubation of the trachea.
Collapse
Affiliation(s)
- Nasser Aldosari
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Shahad Alrashid
- Pediatrics, Alsabah Hospital, Ministry of Health, Kuwait City, KWT
| | - Anwar H Alshareeda
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulaziz Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Mohammad Y Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrahman Almutairi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Yousef Aldweesan
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fay Almajed
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrazzaq Alshakhri
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fai Alwahhabi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | | | - Wardah Albzea
- Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Mahmoud A Alsakka
- Otorhinolaryngology and Facial Plastic Surgery, Canadian Medical Center, Kuwait City, KWT
| | - Raghad Alhajaji
- Family Medicine, Alhajj Primary Health Care, Ministry of Health, Makkah, SAU
| |
Collapse
|