The Effect Of Dexmedetomidine On Propofol Injection Pain:a Meta-analysis

Objective To investigate the effect of dexmedetomidine on propofol injection pain.Methods We searched the Embase,Cochrane Library,MEDLINE and CNKI(China National Knowledge Infrastructure)for randomized controlled trials comparing dexmedetomidine with normal saline on propofol injection pain.According to the pre-set inclusion criteria and exclusion criteria,the two authors screened the literature,extracted the relevant data,and then used software Review Manager 5.3 and Stata 16.0 for the meta-analysis of the final included test.According to the size of heterogeneity,random effect model or fixed effect model were used to combine the effect values,and the size of heterogeneity was expressed by I~2.Subgroup analysis,cumulative meta-analysis,publication bias detection and sensitivity analysis were performed simultaneously.Results A total of 11 clinical randomized controlled trials(total 1277participants)were included in this meta-analysis.The results of meta-analysis showed that the respective incidence of overall propofol injection pain,moderate propofol injection pain and severe propofol injection pain were lower in the dexmedetomidine group than that in the saline group(P<0.05),but there is no difference in the incidence of mild propofol injection pain and adverse reactions(P>0.05).The results of subgroup analysis showed that the incidence of overall propofol injection pain was lower in both the low-dose dexmedetomidine group(<0.5μg/kg)and the high-dose dexmedetomidine group(≥0.5μg/kg)than that in the saline group(P<0.05).But there is no difference in the incidence of adverse reactions(P>0.05).At the same time,the number needed to treat of low-dose and high-dose dexmedetomidine was 3.20 and 3.99 respectively,which indicated that the low-dose dexmedetomidine was better than the high-dose dexmedetomidine in the prevention of propofol injection pain.Among the outcome indicators,the cumulative meta-analysis results of propofol injection pain rate,mild propofol injection pain rate,severe propofol injection pain rate and adverse reactions rate showed that with the addition of large sample study,the combined effect value gradually stabilized,95%confidence interval gradually narrowed,and the accuracy gradually increased.The cumulative meta-analysis results of the incidence of moderate propofol injection pain showed that when joined the study Guo Yingxia et al(2013,31(02):185-187),there were statistical differences in the results of meta-analysis for the first time;then with the increase of sample size,the combined effect value gradually stabilized,the 95%confidence interval gradually narrowed,and the accuracy gradually increased.The results of published bias test showed that there was no published bias in the results of mild propofol injection pain rate and moderate propofol injection pain rate,but there was published bias in the results of propofol injection pain rate and severe propofol injection pain rate.The results showed that the effect amounts of the above outcome indicators treated with the trim and filling method were consistent with that before the trim and filling method used,indicating that the publication bias had no significant impact on the conclusions of the above outcome indicators.The results of sensitivity analysis showed that after the single study was eliminated,the point estimates of the remaining study combined effect amount fell within the 95%confidence interval of the original combined effect amount included in the literature,indicating that the results of meta-analysis of outcome indicators were not affected by the single study,and the results of analysis were relatively stable.Conclusion 1.Dexmedetomidine can prevent propofol injection pain and relieve moderate-severe propofol injection pain,but can’t relieve mild propofol injection pain.While dexmedetomidine does not increase the incidence of adverse reactions.2.Both low-dose dexmedetomidine(<0.5μg/kg)and high-dose dexmedetomidine(≥0.5μg/kg)are effective in preventing propofol injection pain without increasing the incidence of adverse reactions,while low-dose dexmedetomidine has the best effect in preventing propofol injection pain.