Efficacy of dexmedetomidine with spinal block to prolong sedation in elderly patients undergoing transurethral resection of prostate - Meta Analysis

Abstract

Objective: To evaluate the effectiveness of dexmedetomidine in conjunction with spinal anesthesia on the duration of sensory and motor block, hemodynamic parameters, side effects, time to first analgesia, length of stay in the PACU, and excessive sedation in patients undergoing transurethral resection of the prostate (TURP).
Methods: A systematic search was conducted in PubMed, Scopus, the Cochrane Library, and Google Scholar for randomized controlled trials (RCTs) comparing dexmedetomidine with saline in TURP patients. The RoB 2 tool was used to evaluate the quality of the studies, while RevMan was used for statistical analysis.
Results: Five RCTs involving 260 participants met the inclusion criteria. Dexmedetomidine significantly prolonged the duration of sensory block (SMD = 1.05, 95% CI: 0.60 to 1.51, P < 0.00001). It was also associated with the lowest intraoperative heart rate (HR) (SMD = -0.50, 95% CI: -0.86 to -0.15, P = 0.005), lowest systolic blood pressure (SBP) (SMD = -0.61, 95% CI: -1.06 to -0.15, P = 0.009), and lowest mean blood pressure (MBP) (SMD = -0.46, 95% CI: -0.92 to -0.01, P = 0.04). Additionally, dexmedetomidine significantly delayed the time to first analgesia (RR 2.19, 95% CI 1.69–2.70, P < 0.00001). However, no significant differences were observed in the duration of motor block, adverse events (hypotension, bradycardia, and nausea), PACU stay, or excessive sedation.
Conclusion: Dexmedetomidine prolongs sensory block and time to initial analgesia, thereby increasing the effectiveness of spinal anesthesia. It does not lengthen the duration of motor block, increase the frequency of adverse events, or lengthen PACU stay or excessive sedation.