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.

Abstract

Introduction: With an estimated 2.1 million hip and knee replacements performed annually in developed countries, orthopedic surgeries can result in complications such as postoperative pain and cognitive dysfunctions. Dexmedetomidine shows potential for reducing pain and opioid use and improving cognitive outcomes, but its efficacy in orthopedic settings needs further evaluation.

Methods: A comprehensive literature search was performed across electronic databases (e.g., PubMed) up to 1 June 2024 to identify relevant randomized controlled trials (RCTs) investigating the use of dexmedetomidine for orthopedic surgeries. The primary outcomes included visual analog scale (VAS), opioid consumption, incidence of postoperative cognitive dysfunction (POCD), and postoperative delirium (POD). Meta-analysis was conducted using RevMan 5.3 and Stata 16.0, with statistical significance set at P < 0.05. Sensitivity analyses, along with trial sequential analysis (TSA), were used to evaluate the robustness of the findings.

Results: The meta-analysis included 59 RCTs with 7713 participants and demonstrated that dexmedetomidine significantly reduced postoperative VAS score (mean difference [MD] -0.50, P = 0.0003) and opioid consumption (MD -11.91, P < 0.0001) and decreased the incidence of POCD (risk ratio [RR] 0.59, P = 0.006) and POD (RR 0.49, P < 0.0001). Dexmedetomidine also prolonged motor (MD: 1.70, P < 0.0001) and sensory block durations (MD: 1.80, P < 0.0001) and delayed the time to first rescue analgesics (MD: 1.51, P < 0.0001). TSA and sensitivity analysis confirmed the robustness and reliability of the results, whereas meta-regression revealed no significant effect of variables on primary outcomes.

Conclusion: Our study demonstrates that intravenous dexmedetomidine significantly improved postoperative pain and neurocognitive functions in orthopedic surgery patients.