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

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 difference(4h) = -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 difference(0-24h) = -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.