Efficacy of perioperative dexmedetomidine in postoperative pain and neurocognitive functions in orthopedic surgery: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials.

Summary

Across 59 randomized trials (n=7,713), dexmedetomidine reduced postoperative pain (MD -0.50 VAS), opioid consumption (MD -11.91), and the incidence of POCD (RR 0.59) and POD (RR 0.49) after orthopedic surgery. Trial sequential analyses and sensitivity analyses supported result robustness.

Key Findings

• Reduced postoperative pain (VAS MD -0.50) and opioid consumption (MD -11.91).
• Lower incidence of postoperative cognitive dysfunction (RR 0.59) and postoperative delirium (RR 0.49).
• Prolonged motor (MD 1.70) and sensory block (MD 1.80) and delayed time to first rescue analgesic (MD 1.51); TSA supported robustness.

Clinical Implications

Consider dexmedetomidine as part of multimodal analgesia/sedation in orthopedic surgery to reduce pain, opioids, delirium, and cognitive dysfunction; monitor for bradycardia and hypotension and tailor dosing to patient comorbidities.

Limitations

• Heterogeneity in dosing regimens, surgical procedures, and outcome timing across RCTs
• Potential publication bias and limited reporting of adverse events across trials

Future Directions

Head-to-head trials to optimize dexmedetomidine dosing/timing and to balance hemodynamic risks; evaluation in high-risk cognitive populations with standardized delirium/cognition endpoints.