Efficacy of Adjuvants in Ophthalmic Regional Anesthesia: A Systematic Review and Network Meta-analysis

center dot PURPOSE: This network meta-analysis aims to deter-mine the differences between adjuvants that are used in combination with local anesthetics for ophthalmic re-gional anesthesia.center dot DESIGN: Systematic review and network meta-analysis.center dot METHODS: A systematic literature search for random-ized controlled trials, comparing the impact of adjuvants in ophthalmic regional anesthesia, in Embase, CEN-TRAL, MEDLINE and Web of Science was performed. Risk of bias was evaluated using the Cochrane risk of bias tool. Frequentist network meta-analysis was performed using a random effects model with saline as the compara-tor. Primary endpoints were the onset and the duration of sensory block and globe akinesia, as well as the duration of analgesia. Summary measure was the ratio of means (ROM). Secondary endpoints were the rates of side ef-fects and adverse events.center dot RESULTS: A total of 39 trials were identified as eligi-ble for network meta-analysis, including 3046 patients. In all, 17 adjuvants were compared in the most extensive network (onset of globe akinesia). The addition of fen-tanyl (F), clonidine (C), or dexmedetomidine (D) showed the best overall results. Onset of sensory block was as fol-lows: F 0.58 (CI = 0.47-0.72), C 0.75 (0.63-0.88), D 0.71 (0.61-0.84); onset of globe akinesia: F 0.71 (0.61-0.82), C 0.70 (0.61-0.82), D 0.81 (0.71-0.92); dura-tion of sensory block: F 1.20 (1.14-1.26), C 1.22 (1.18-1.27), D 1.44 (1.34-1.55); duration of globe akinesia: F 1.38 (1.22-1.57), C 1.45 (1.26-1.67), D 1.41 (1.24-1.59); and duration of analgesia: F 1.46 (1.33-1.60), C 1.78 (1.63-1.96), D 1.41 (1.28-1.56).center dot CONCLUSIONS: : The addition of fentanyl, clonidine, or dexmedetomidine showed beneficial effects regarding onset and duration of sensory block and globe akinesia.(Am J Ophthalmol 2023;252: 26-44. (c) 2023 Elsevier Inc. All rights reserved.)