Dexmedetomidine reduces postoperative pain and speeds recovery after bariatric surgery: a meta-analysis of randomized controlled trials

Background: Dexmedetomidine in opioid-sparing analgesia promotes enhanced recovery and improves postoperative outcomes. Objectives: This study aimed to explore the safety and efficacy of dexmedetomidine in bariatric surgery. Setting: Meta-analysis. Methods: We selected studies from Pubmed, Embase, Web of Science, and the Cochrane Central Registry of Controlled Trials before 20 April, 2021. The primary outcomes were pain scores and intravenous morphine equivalents (IVME) in the post anesthesia care unit (PACU) and postoperative day 1 (POD1). The secondary outcomes included postoperative nausea and vomiting (PONV), the length of hospital stay (LOS), intraoperative mean arterial pressure (MAP) and heart rate (HR). Results: We extracted 697 participants from 10 randomized controlled trials. Dexmedetomidine reduced PACU pain scores (MD = -1.51, 95% confidence interval [CI]: -2.60 to -.42) after bariatric surgery, especially laparoscopic Roux-en-Y gastric bypass (MD = -3.05, 95%CI: -3.77 to -2.33), but it did not affect POD1 pain scores (MD = .20, 95%CI: -.85 to 1.26). Dexmedetomidine can reduce PACU IVME (MD = -4.29, 95%CI: -6.59 to -1.99), but does not reduce POD1 IVME (MD = -.36, 95%CI: -2.41 to 1.68). In addition, dexmedetomidine significantly reduced PONV both in PACU (OR = .28, 95%CI: .14-.54) and POD1 (OR = .24, 95%CI: .14-.4), shortened LOS (MD = -.29, 95%CI: -.49 to -.10), and had little effect on intraoperative MAP (MD = -6.64, 95%CI: -9.52 to -3.76) and HR (MD = -4.8, 95%CI: -11.55 to 1.94). Conclusion: In conclusion, the use of dexmedetomidine in opioid-sparing analgesia contributes to postoperative analgesia after bariatric surgery, but the heterogeneity was high. In addition, dexmedetomidine is beneficial for enhanced recovery. (C) 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.