Abstract
The aim of this study is to evaluate the benefits of dexmedetomidine in epidural labor analgesia compared with lipophilic opioids. The databases of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, and SinoMed were searched from inception to Mar. 25, 2021 for randomized controlled trials (RCT) that assessed dexmedetomidine versus lipophilic opioids as adjuvants to local anesthetics in epidural labor analgesia. Meta-analyses were conducted with RevMan 5.3, and a random-effects model was adopted. A total of 11 RCTs involving 1099 parturients were enrolled. The results showed that, compared with the control group, dexmedetomidine significantly reduced Visual Analogue Scale (VAS) scores both at 30 minutes after induction [weighted mean difference (WMD) = –0.40, 95% CI: –0.61 to –0.20] and on delivery (WMD = –0.83, 95% CI: –1.15 to –0.50), reduced analgesic consumption (WMD = –6.29 mL, 95% CI: –10.49 to –2.10), shortened the duration of the first (WMD = –9.58 minutes, 95% CI: –18.12 to –1.04) and second (WMD = –1.66 minutes, 95%CI: –3.20 to –0.12) stage of labor, increased maternal bradycardia [risk ratio (RR) = 2.44, 95% CI: 1.31 to 4.53] and motor blockade (RR = 5.30, 95% CI: 2.21 to 12.73), reduced nausea/vomiting (RR = 0.34, 95% CI: 0.20 to 0.57), pruritis (RR= 0.19, 95%CI: 0.06 to 0.58) and shivering (RR = 0.37, 95% CI: 0.18 to 0.77). There was no significant difference between groups in the rate of instrumental delivery (p = 0.68), and cesarean delivery (p = 0.40), Apgar scores at 1 minute (p = 0.24), at 5 minutes (p = 0.36), and the umbilical arterial PH (p = 0.16). In summary, compared to lipophilic opioids, dexmedetomidine for epidural labor analgesia reduced analgesic agent consumption and resulted in fewer maternal complications.