Better pain reduction with dexmedetomidine after knee, hip replacement

  • Yang Q & al.
  • Medicine (Baltimore)
  • 01/01/2020

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) who receive dexmedetomidine have significantly less pain.
  • They also are less likely to develop postoperative delirium and postoperative nausea and vomiting (PONV) compared with those who receive saline, ropivacaine, bupivacaine, or propofol, with similar risks for hypotension.
  • Among TKA patients, the use of dexmedetomidine is associated with a significantly higher risk for bradycardia.

Why this matters

  • Despite its known efficacy, dexmedetomidine was associated in previous studies with increased risk for hypotension and bradycardia requiring atropine.

Study design

  • Systematic review and meta-analysis of 14 randomized controlled trials (N=1220) on patients undergoing TKA/THA.
  • Funding: The National Natural Science Foundation, China.

Key results

  • Dexmedetomidine significantly decreased pain scores after 24 hours of surgery (weighted mean difference [WMD], −0.36; I2, 90.0%; P<.001>
  • Dexmedetomidine vs control groups showed decreased:
    • Postoperative delirium rates: relative risk (RR), 0.38 (I2=0.0%; P<.001>
    • Risks for postoperative nausea and vomiting in patients undergoing TKA: RR, 0.34 (I2, 0.0%; P<.01>
  • Similar incidences for hypotension were noted between the dexmedetomidine and control groups: RR, 1.03 (I2, 24.4%; P=.87).
  • In patients undergoing TKA, dexmedetomidine increased the risks for bradycardia: RR, 6.11 (I2, 0.0%; P<.001>

Limitations

  • Studies not highly powered.

Coauthored with Chitra Ravi, MPharm