Effects of Combining Dexmedetomidine and Opioids for Postoperative Intravenous Patient-controlled Analgesia: A Systematic Review and Meta-analysis

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Abstract

Objectives:

This meta-analysis evaluated the effects of opioid-dexmedetomidine (DEX) combinations for postoperative patient-controlled analgesia (PCA).

Materials and Methods:

A systematic literature search was conducted to identify randomized controlled trials comparing opioid-DEX combinations to opioid alone for intravenous PCA up to postoperative 24 hours in adult patients. Outcomes included postoperative pain intensity, opioid consumption, and adverse events.

Results:

Seven randomized controlled trials were included. Compared with opioid alone, postoperative intravenous opioid-DEX combination PCA strategies led to lower postoperative pain intensity (mean difference4 h=−0.83 [on a 0 to 10 scale], 95% confidence interval [CI]: −1.34 to −0.32, P=0.002), lower postoperative morphine-equivalent consumption (mean difference0-24 h=−16.46 mg, 95% CI: −23.65 to −9.27, P<0.00001), and lower incidence of postoperative nausea (risk ratio [RR]=0.42, 95% CI: 0.30 to 0.58, P<0.00001), vomiting (RR=0.38, 95% CI: 0.16 to 0.89, P=0.02), and pruritus (RR=0.59, 95% CI: 0.35 to 1.00, P=0.05). More patients were satisfied with PCA when opioids were combined with DEX (RR=1.14, 95% CI: 1.02 to 1.29, P=0.02).

Discussion:

These data suggest that an opioid-DEX combination is a safe and effective strategy for postoperative intravenous PCA.

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