Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis
Background: In combination with local anesthetics such as levobupivacaine, fentanyl, and dexmedetomidine improve post-operative analgesia after surgery on the lower extremities. Aims and Objectives: To determine whether the local anesthetic levobupivacaine in combination with fentanyl or dexmedet...
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Manipal College of Medical Sciences, Pokhara
2025-03-01
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| Series: | Asian Journal of Medical Sciences |
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| Online Access: | https://ajmsjournal.info/index.php/AJMS/article/view/4352 |
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| author | Mohit Gupta Rana Pratap Gajendra Pal Singh |
| author_facet | Mohit Gupta Rana Pratap Gajendra Pal Singh |
| author_sort | Mohit Gupta |
| collection | DOAJ |
| description | Background: In combination with local anesthetics such as levobupivacaine, fentanyl, and dexmedetomidine improve post-operative analgesia after surgery on the lower extremities.
Aims and Objectives: To determine whether the local anesthetic levobupivacaine in combination with fentanyl or dexmedetomidine can improve the efficacy and duration of analgesia in lower extremity surgery.
Materials and Methods: After a search in PubMed, Google, and Web of Science, six randomized controlled trials with 400 patients were found. Review Manager 5 was then used to retrieve the study results and calculate the effect sizes.
Results: The effects of 0.5% levobupivacaine with fentanyl (group F) and dexmedetomidine (group D) on sensory blockade, regression, and post-operative analgesia were investigated in numerous studies. Group D had a significant advantage in sensory regression (standard mean difference [SMD] −3.34, confidence interval [CI] [−4.07, −2.62], P<0.00001), although there was no significant difference in the onset of sensory blockade (SMD −0.21, CI [−1.28, 0.86], dexmedetomidine prolonged post-operative analgesia (SMD −7.34, CI [−11.08, −3.60], P=0.0001). The heterogeneity between the studies was substantial (I²=59–97%). The methodological excellence of the selected studies was reflected in their low risk of bias in all areas.
Conclusion: Despite the identical onset of sensory blockade, dexmedetomidine prolongs sensory regression and post-operative analgesia more than fentanyl. Despite considerable variability, these results are supported by a low bias, making dexmedetomidine a better adjuvant for analgesia in chronic lower extremity surgery. |
| format | Article |
| id | doaj-art-53f21f242a8447978da95dc4db1fd2d4 |
| institution | OA Journals |
| issn | 2467-9100 2091-0576 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Manipal College of Medical Sciences, Pokhara |
| record_format | Article |
| series | Asian Journal of Medical Sciences |
| spelling | doaj-art-53f21f242a8447978da95dc4db1fd2d42025-08-20T02:11:17ZengManipal College of Medical Sciences, PokharaAsian Journal of Medical Sciences2467-91002091-05762025-03-011631523https://doi.org/10.71152/ajms.v16i3.4352Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysisMohit Gupta 0https://orcid.org/0009-0004-6998-3815Rana Pratap1https://orcid.org/0009-0007-9904-3295Gajendra Pal Singh 2https://orcid.org/0009-0006-5714-439XAssistant Professor, Department of Anesthesia, Gautam Buddha Chikitsa Mahavidyalaya, Dehradun, Uttarakhand, India Assistant Professor, Department of Anaesthesiology, Mahamaya Rajkiya Allopathic Medical College, Ambedkar Nagar, Uttar Pradesh, India Assistant Professor, Department of Anaesthesia, SRMS Institute of Medical Science, Bareilly, Uttar Pradesh, India Background: In combination with local anesthetics such as levobupivacaine, fentanyl, and dexmedetomidine improve post-operative analgesia after surgery on the lower extremities. Aims and Objectives: To determine whether the local anesthetic levobupivacaine in combination with fentanyl or dexmedetomidine can improve the efficacy and duration of analgesia in lower extremity surgery. Materials and Methods: After a search in PubMed, Google, and Web of Science, six randomized controlled trials with 400 patients were found. Review Manager 5 was then used to retrieve the study results and calculate the effect sizes. Results: The effects of 0.5% levobupivacaine with fentanyl (group F) and dexmedetomidine (group D) on sensory blockade, regression, and post-operative analgesia were investigated in numerous studies. Group D had a significant advantage in sensory regression (standard mean difference [SMD] −3.34, confidence interval [CI] [−4.07, −2.62], P<0.00001), although there was no significant difference in the onset of sensory blockade (SMD −0.21, CI [−1.28, 0.86], dexmedetomidine prolonged post-operative analgesia (SMD −7.34, CI [−11.08, −3.60], P=0.0001). The heterogeneity between the studies was substantial (I²=59–97%). The methodological excellence of the selected studies was reflected in their low risk of bias in all areas. Conclusion: Despite the identical onset of sensory blockade, dexmedetomidine prolongs sensory regression and post-operative analgesia more than fentanyl. Despite considerable variability, these results are supported by a low bias, making dexmedetomidine a better adjuvant for analgesia in chronic lower extremity surgery.https://ajmsjournal.info/index.php/AJMS/article/view/4352spinal block; post-operative pain; adjuvant; sensory block; motor block |
| spellingShingle | Mohit Gupta Rana Pratap Gajendra Pal Singh Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis Asian Journal of Medical Sciences spinal block; post-operative pain; adjuvant; sensory block; motor block |
| title | Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis |
| title_full | Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis |
| title_fullStr | Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis |
| title_full_unstemmed | Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis |
| title_short | Efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery: A meta-analysis |
| title_sort | efficacy and duration of analgesia with levobupivacaine combined with fentanyl or dexmedetomidine in lower extremity surgery a meta analysis |
| topic | spinal block; post-operative pain; adjuvant; sensory block; motor block |
| url | https://ajmsjournal.info/index.php/AJMS/article/view/4352 |
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