Effectiveness of Intraoperative Dexmedetomidine for Postoperative Pain Management
Dexmedetomidine (Dex) has been known to offer significant sedative, analgesic and anesthetic-sparing effects. According to recent studies, Dex can be useful in specific anesthetic situations. One of current meta-analysis, proved the ability of Dex in reducing the intraoperative opioid consumption, pain intensity during postanesthesia care unit (PACU) stay, opioid consumption during postanesthesia care unit (PACU) or intensive care unit (ICU) stay, and postoperative nausea and vomiting (PONV) incidence during PACU stay.
In order to explore more on this subject, a group of investigators conducted a meta-analysis study which focused on establishing the intraoperative and postoperative effects of intraoperative Dex administration during pediatric surgery.
Randomized-placebo controlled trials were searched to recognize the clinical trials that investigated intraoperative Dex use in children, infants, and neonates. Postoperative opioid consumption was the primary outcome and postoperative pain intensity or postoperative nausea vomiting (PONV) were the secondary outcomes.
The analysis included 14 randomized controlled trials and it was found that intraoperative Dex administration was linked to significantly reduced postoperative opioid consumption in the postanesthesia care unit [PACU; risk ratio (RR) = 0.31 (0.17, 0.59), I 2 = 76%, p < 0.0001 and cumulative z score using trial sequential analysis], decreased pain intensity in PACU [standardized mean difference (SMD) = −1.18 (−1.88, −0.48), I 2 = 91%, p < 0.0001] but had no effect upon PONV incidence [RR = 0.67 (0.41, 1.08), I 2 = 0%, p = 0.48]. Among the results, heterogeneity was the highest and a high suspicion of publication bias was there for all analyzed outcomes.
The results of meta-analysis showed that there was a significant reduction in postoperative opioids consumption and postoperative pain in PACU after the administration of intraoperative Dex in children. The optimal bolus dose was found to be ≥0.5 µg/kg. These findings suggest the need to discover more about the dose and postoperative analgesic effects of Dex during longer periods.