Dexmedetomidine as a sedative and analgesic adjuvant in spine surgery: a systematic review and meta-analysis of randomized controlled trials
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This systematic review and meta-analysis appraise the clinical evidence on efficacy and safety of dexmedetomidine (DEX), as a sedative and analgesic adjunct in adult patients undergoing spine surgery.
A database search was conducted to identify randomized clinical trials (RCTs) pertinent to the perioperative use of DEX in spine surgery. Sedative and analgesic efficacy of DEX constituted the primary outcomes, whilst the incidence of hemodynamic changes, quality of recovery and occurrence of adverse events served as secondary ones.
Fifteen studies enrolling a total of 913 patients were selected for qualitative analysis, among which eight RCTs incorporating a placebo comparison group were included in the meta-analysis. Most of the retrieved studies were of moderate to good quality and demonstrated an acceptable risk of bias. DEX-treated patients showed a significant reduction of both propofol [mean difference (MD), −214.47 mg; 95%CI, −253.16 to −175.78; P < 0.001] and morphine equivalents consumption both intraoperatively and postoperatively (MD, −2.69; 95% CI, −3.05 to −2.33; P < 0.001 and MD, −4.36 mg; 95%CI, −6.93 to −1.79; P < 0.001, respectively) compared to those assigned to placebo. Postoperative nausea and vomiting incidence were comparable between DEX and placebo groups, whilst other adverse events were not consistently reported.
DEX emerges as an attractive alternative to standard sedative and analgesic modalities applied in spine surgery, by attaining a notable sedative and opioid-sparing effect, which goes with an enhanced safety profile. Yet, no definite conclusion can be drawn due to the considerable heterogeneity of available data.
KeywordsDexmedetomidine Spine surgery Sedative efficacy Analgesic efficacy PONV, adverse events
Contributions of authors statement
1. Georgia Tsaousi: conception and design of the work; acquisition, analysis, and interpretation of data; wrote the paper; drafted the work or revised it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.
2. Chryssa Pourzitaki: acquisition, analysis, and interpretation of data; wrote the paper; Drafted the work or revised it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.
3. Simone Aloisio: acquisition and interpretation of data; Drafted the work or revised it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.
4. Federico Bilotta: conception and design of the work; interpretation of data; drafted the work or revised it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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