Dexmedetomidine as a sedative and analgesic adjuvant in spine surgery: a systematic review and meta-analysis of randomized controlled trials
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.
- 4.Sekimoto K, Nishikawa K, Ishizeki J, Kubo K, Saito S, Goto F (2006) The effects of volatile anesthetics on intraoperative monitoring of myogenic motor-evoked potentials to transcranial electrical stimulation and on partial neuromuscular blockade during propofol/fentanyl/nitrous oxide anesthesia in humans. J Neurosurg Anesthesiol 18:106–111CrossRefPubMedGoogle Scholar
- 15.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339. https://doi.org/10.1136/bmj.b2700 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, http://handbook.cochrane.org
- 18.Higgins JP, Altman DG, Gotzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials. BMJ 343:d5928CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Bojaraaj DRK, Senthilkumar S, Vijayaragavan S, Gnanavelrajan A (2016) Effect of intravenous use of dexmedetomidine on anesthetic requirements in patients undergoing elective spine surgery: A double-blinded randomized controlled trial. International J Scientific Study 4:251–255Google Scholar
- 25.Srivastava VK, Mishra A, Agrawal S, Kumar S, Sharma S, Kumar R (2016) Comparative evaluation of dexmedetomidine and magnesium sulphate on propofol consumption, hemodynamics and postoperative recovery in spine surgery: a prospective, randomized, placebo-controlled, double-blind study. Adv Pharm Bull 6:75–81CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Gandhi KA, Panda NB, Vellaichamy A, Mathew PJ, Sahni N, Batra YK (2017) Intraoperative and postoperative administration of dexmedetomidine reduces anesthetic and postoperative analgesic requirements in patients undergoing cervical spine surgeries. J Neurosurg Anesthesiol 29:258–263CrossRefPubMedGoogle Scholar
- 31.Mariappan R, Ashokkumar H, Kuppuswamy B (2014) Comparing the effects of oral clonidine premedication with intraoperative dexmedetomidine infusion on anesthetic requirement and recovery from anesthesia in patients undergoing major spine surgery. J Neurosurg Anesthesiol 26:192–197CrossRefPubMedGoogle Scholar
- 32.Garg N, Panda NB, Gandhi KA, Bhagat H, Batra YK, Grover VK, Chhabra R (2016) Comparison of small dose ketamine and dexmedetomidine infusion for postoperative analgesia in spine surgery - a prospective randomized double-blind placebo controlled study. J Neurosurg Anesthesiol 28:27–31CrossRefPubMedGoogle Scholar
- 36.Jamaliya RH, Chinnachamy R, Maliwad J, Deshmukh VP, Shah BJ, Chadha IA (2014) The efficacy and hemodynamic response to Dexmedetomidine as a hypotensive agent in posterior fixation surgery following traumatic spine injury. J Anaesthesiol Clin Pharmacol 30:203–207CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Kaskinoro K, Maksimow A, Långsjӧ J, Aantaa R, Jääskeläinen S, Kaisti K, Särkelä M, Scheinin H (2011) Wide inter-individual variability of bispectral index and spectral entropy at loss of consciousness during increasing concentrations of dexmedetomidine, propofol, and sevoflurane. Br J Anaesth 107:573–580CrossRefPubMedGoogle Scholar
- 48.Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J, Dexmedetomidine for Long-Term Sedation Investigators (2012) Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 307:1151–1160CrossRefPubMedGoogle Scholar