Perioperative dexmedetomidine for pain management in craniotomy: a systematic review and meta-analysis

Abstract

BackgroundCraniotomy is associated with several undesirable effects including postoperative pain. This systematic review and meta-analysis aimed to evaluate evidence on the efficacy and safety of dexmedetomidine (DEX) for pain management in patients undergoing craniotomy. MethodsWe followed PRISMA guidelines. The protocol was registered in Open Science Framework. We searched for existing randomized controlled studies (RCTs) published before June 2023 that used dexmedetomidine during the perioperative period in craniotomy in PubMed, Scopus, and the Cochrane Library. A meta-analysis was conducted in RevMan. Cochrane RoB2 and GRADE were used for quality assessment. ResultsA total of 19 RCTs comprising 3,153 patients were included. Pain intensity was lower in the DEX group than the control group at a mean difference (MD) [95% confidence interval (CI)] of –0.64 [–1.16, –0.13], p-value=0.01. The DEX group overall consumed less opioids in comparison with the control group at an MD=–4.00 [–6.16, –1.83], p-value=0.0003. However, heterogeneity was considerable for both outcomes (I2=81% and I2=96%, respectively). There was no difference between the DEX and control groups in the time to first post-analgesic requirement, hypertension, hypotension, or cough. ConclusionsThe results showed that the use of dexmedetomidine was associated with lower pain intensity and less opioid use. Patients in the DEX group experienced fewer episodes of nausea and vomiting, agitation, and shivering but more episodes of bradycardia. There was no difference between DEX and control groups in other adverse events.