Wound infiltration of dexmedetomidine as an adjunct to local anesthesia in postoperative analgesia for lumbar surgery

INTRODUCTION: Most patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery. EVIDENCE ACQUISITION: Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library; Web of Science. CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms "dexmedetomidine." "infiltration," and "lumbar." The random-effect model was used to perform the meta-analysis based on deviance information criteria. EVIDENCE SYNTHESIS: Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with demedetomidine significantly reduced the postoperative VAS scores (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; P=0.0003); 24th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; P<0.00001); 6th hour dynamic VAS scores (MD -1.84; 95% CI: -223 to -1.45; P<0.00001) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; P<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95 % CI:2.31 to 4.76; P<0.00001), and reduced the incidence of nausea or vomiting (RRO.40; 95% CI: 0.17 to 0.93; P<0.05). CONCLUSIONS: Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.