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Dexmedetomidine Reduces Perioperative Opioid Consumption and Postoperative Pain Intensity in Neurosurgery: A Meta-analysis

Liu, Yi, MSc*; Liang, Feng, MD; Liu, Xiaochen, MD; Shao, Xinxin, MSc*; Jiang, Nan, MD, PhD*; Gan, Xiaoliang, MD§

Journal of Neurosurgical Anesthesiology: April 2018 - Volume 30 - Issue 2 - p 146–155
doi: 10.1097/ANA.0000000000000403
Clinical Investigations
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Background: Dexmedetomidine (DEX) has been administered to patients during neurosurgery. Some studies have found that DEX could reduce perioperative opioid consumption and postoperative pain intensity. However, no firm conclusions have been reached. The purpose of this meta-analysis was to assess the efficacy of DEX for managing pain in neurosurgical patients.

Materials and Methods: A comprehensive literature review was conducted to identify randomized controlled trials (RCTs) focusing on the effects of DEX on perioperative opioid consumption and postoperative pain intensity in patients undergoing neurosurgery. PubMed, the Web of science, the Cochrane Library, and Scopus were searched. The resulting data were combined to calculate the pooled mean differences (MDs), standard MDs or odds ratios (ORs), and 95% confidence intervals (CIs), as appropriate. Heterogeneity and potential publication bias were assessed. Furthermore, a trial sequential analysis was performed to improve the precision of our findings.

Results: A total of 11 published RCTs involving 674 patients undergoing neurosurgery (335 patients, 339 controls) were included in this meta-analysis. There were significant differences in postanesthesia care unit (PACU) visual analog scale scores between the groups (MD=−1.54, 95% CI, −2.33 to 0.75, I2=87%, P=0.0001). In addition, there were significant differences in PACU opioid requirements between the treatment and control groups (standard MD=−0.88, 95% CI, −1.74 to 0.02, I2=91%, P=0.05). Furthermore, intraoperative opioid consumption was significantly reduced in the treatment group (MD=−127.75, 95% CI, −208.62 to 46.89, I2=98%, P=0.002).

Conclusions: DEX could reduce perioperative and PACU opioid consumption as well as postoperative pain intensity.

Departments of *Anesthesiology

Neurosurgery, the First Affiliated Hospital

Medical College

§Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China

Y.L. and F.L. contributed equally.

The authors have no funding or conflicts of interest to disclose.

Address correspondence to: Nan Jiang, MD, PhD, Department of Anesthesiology, The first affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China (e-mail: NJiang_sysu@126.com).

Received September 8, 2016

Accepted December 1, 2016

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