| Objective:Evaluation of the effect of dexmedetomidine combined with local anesthetics in brachial plexus block.Methods:Relevant documents were searched in databases such as Pubmed,Embase,Cochrane Library,China HowNet,Wanfang Medical Network,and Weipu.The deadline for the search was December 2019,and the languages were Chinese and English.Two researchers independently screened the literature and extracted data according to the screening criteria,and the results were analyzed using Revman5.3 software.Results:A total of 24 articles were included(n = 1612).Both perineural and IV dexmedetomidine can effectively prolong the BPB analgesic duration(WMD=182.91,95%CI [129.85,235.96],I2=98%,P<0.00001)(WMD=180.47,95%CI[83.01,277.93],I2=98%,p=0.0003);Perineural application can also extend the duration of motor block(WMD=147.57,95%CI[120.81,174.33],I2=99%,P<0.00001).Compared with the IV group,the perineural group has an advantage in extending the duration of analgesia and the duration of motor block(WMD =69.24,95%CI [24.92,113.56],I2=53%,P<0.002)(WMD=74.35,95%CI [47.68,101.01],P<0.00001).After applying dexmedetomidine,the most common adverse reaction was bradycardia(RR=5.08,95%CI[3.25,7.93],I2=29%,P<0.00001).Conclusion:Both perineural and IV dexmedetomidine can effectively prolong the BPB analgesic duration when combined with local anesthetics,but at the same time increase the incidence of bradycardia.Compared with the IV group,the perineural group has an advantage in extending the duration of analgesia and the duration of motor block.Judging from the prolonged time of nerve block,50 ug may be the best dose of the dexmedetomidine perineural route,but from the incidence of bradycardia,the 1ug / kg dose is better than 50 ug.Therefore,the clinician should choose according to the patient’s situation. |
