Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta‐analysis of randomized controlled trials. Issue 2 (9th October 2012) - Schnabel, Alexander
Summary Background Aim of the current meta‐analysis was to assess the effects of intraoperative dexmedetomidine on postoperative pain, analgesic consumption, and adverse events in comparison with placebo or opioids in children undergoing surgery. Methods This meta‐analysis was performed according to the recommendations of the PRISMA statement and the Cochrane collaboration. For dichotomous and continuous outcomes of efficacy and adverse events, the Revman® (The Nordic Cochrane Centre, Copenhagen, Denmark) statistical software was used to calculate relative risk (RR), mean difference (MD), and 95% confidence intervals (CI). Results We included 11 randomized controlled trials – 434 children received dexmedetomidine, 440 received control. In comparison with placebo, children receiving dexmedetomidine showed a reduced RR for postoperative opioids (0.4; 95% CI: 0.26–0.62; P < 0.00001) and postoperative pain (0.51; 95% CI: 0.32–0.81; P = 0.004). Similar results were obtained for the comparison with intraoperative opioids: reduced RR for postoperative pain (0.49; 95% CI: 0.25–0.94; P = 0.03) and the need for postoperative opioids (0.77; 95% CI: 0.60–1.09; P = 0.05). Conclusions This meta‐analysis revealed a lower risk for postoperative pain and the need for postoperative opioids following intraoperative dexmedeto‐midine in comparison with placebo or opioids in children undergoing surgery; however, the influence of dexmedetomidine on postoperative opioid consumption is less clear. Although there were only a limited number of adverse events, further studies focusing on procedure specific dexmedetomidine dosing and adverse events are urgently needed.