Efficacy of dexmedetomidine in postoperative nausea and vomiting in laparoscopic bariatric surgery: A systematic review and meta-analysis of randomised clinical trials.

Abstract

Introduction: Postoperative nausea and vomiting (PONV) is a common side effect of all types of surgeries, especially so in bariatric surgery. Dexmedetomidine (DX) is an α2-agonist that may be useful as an adjunct prophylactic medication for PONV. This meta-analysis aims to evaluate the efficacy of DX in reducing the incidence and severity of PONV in laparoscopic bariatric surgeries.

Materials and methods: Databases were searched for articles with the determined MESH terms and keywords before February 2022. Identified articles were screened and 13 randomised clinical trials (RCTs) were included in this meta-analysis based on the inclusion criteria. Data were extracted from the articles and statistical analysis was performed using Review Manager.

Results: Administration of DX significantly reduced the incidence of PONV and Numerical Rating Scale (NRS) scores for PONV. The outcome was probably due to the intrinsic sympatholytic effect of the medication, reduction of postoperative pain and total postoperative opioid usage. DX showed better efficacy as PONV prophylaxis if the duration of surgery was < 120 minutes. Delivery of DX as a continuous infusion without a loading dose before infusion was found to be effective in reducing PONV compared to infusion after a loading dose.

Conclusion: Administration of DX can reduce the incidence of PONV in patients undergoing laparoscopic bariatric surgery. However, further studies are required to investigate the optimal dose of DX as an antiemetic, considering its side effects to increase the applicability of our results in future guidelines for laparoscopic bariatric surgery.