{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:42:46Z","timestamp":1787013766319,"version":"build-2736575974"},"reference-count":117,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We review the efficacy and safety of dexmedetomidine and clonidine as perineural or systemic adjuvants for brachial plexus blocks (BPB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included randomised controlled trials on upper limb surgery with BPBs in adults, comparing dexmedetomidine with clonidine or either drug with placebo. The primary outcome was duration of analgesia. Secondary outcomes included adverse and serious adverse events. The review was conducted using Cochrane standards, trial sequential analyses (TSA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 101 trials with 6248 patients. Overall, duration of analgesia was prolonged with both clonidine (176\u00a0min [TSA adj. 95% CI: 118, 205,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.00001; 33 trials]) and dexmedetomidine (292\u00a0min [TSA adj. 95% CI: 245\u00a0329,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.00001; 53 trials]), but was longer for dexmedetomidine than clonidine (205\u00a0min [TSA adj. 95% CI: 157, 254,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.00001; 19 trials]). Compared with placebo, dexmedetomidine was associated with bradycardia (RR 4.2 [95% CI 2.2, 8.3]), and both clonidine (RR 4.5 [95% CI 1.1, 18.3]) and dexmedetomidine (RR 3.9 [95% CI 2.0, 7.5]) were associated with hypotension. Serious adverse events were mostly related to block technique. GRADE\u2010rated quality of evidence was low or very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Alpha2\u2010receptor agonists used as adjuvants for BPBs lead to a prolonged duration of analgesia, with dexmedetomidine as the most efficient. Alpha2\u2010receptor agonists were associated with increased risk of cardiovascular adverse events. The quality of evidence was low to very low.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.14002","type":"journal-article","created":{"date-parts":[[2021,11,23]],"date-time":"2021-11-23T04:54:27Z","timestamp":1637643267000},"page":"186-206","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Alpha\n                    <sub>2<\/sub>\n                    \u2010receptor agonists as adjuvants for brachial plexus nerve blocks\u2014A systematic review with meta\u2010analyses"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1402-8162","authenticated-orcid":false,"given":"Jakob H.","family":"Andersen","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital  K\u00f8ge Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0338-3751","authenticated-orcid":false,"given":"Anders","family":"Karlsen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital  K\u00f8ge Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2461-2672","authenticated-orcid":false,"given":"Anja","family":"Geisler","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital  K\u00f8ge Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"J\u00e6ger","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Centre of Head and Orthopedics, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrik","family":"Grevstad","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Gentofte Hospital  Hellerup Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f8rgen B.","family":"Dahl","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Bispebjerg and Frederiksberg Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ole","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital  K\u00f8ge Denmark"},{"name":"Department of Clinical Medicine Copenhagen University  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14966-5"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200209000-00025"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201201000-00005"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03036962"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181fa3095"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2009.06.005"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-5-13"},{"key":"e_1_2_9_10_1","unstructured":"http:\/\/www.ctu.dk\/tsa\/downloads.aspx"},{"key":"e_1_2_9_11_1","unstructured":"ThorlundKEJ WetterslewJ BrokJ ImbergerG GluudC.User Manual for Trial Sequential Analysis (TSA). 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