• World Neurosurg · Oct 2024

    Meta Analysis

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

    • Dmitriy Viderman, Mina Aubakirova, Assel Nemerenova, Azamat Salamat, and Yerkin G Abdildin.
    • School of Medicine (NUSOM), Nazarbayev University, Astana, Kazakhstan; Department of Anesthesiology, Intensive Care, and Pain Medicine, National Research Oncology Center, Astana, Kazakhstan. Electronic address: dmitriy.viderman@nu.edu.kz.
    • World Neurosurg. 2024 Oct 1; 190: e93e108e93-e108.

    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 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in Open Science Framework. We searched for existing randomized controlled studies published before June 2023 that used DEX 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 randomized controlled trials comprising 3153 patients were included. Pain intensity was lower in the DEX group than the control group at a mean difference [95% confidence interval] 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 a mean difference = -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 postanalgesic requirement, hypertension, hypotension, or cough.ConclusionsThe results showed that the use of DEX 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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