Dexmedetomidine for the prevention of chronic postsurgical pain: a systematic review and meta-analysis

BACKGROUND: Chronic postsurgical pain (CPSP), defined as pain persisting beyond the normal healing period, is a significant surgical complication. This systematic review evaluated the effectiveness of dexmedetomidine in preventing CPSP. METHODS: A systematic search of PubMed/MEDLINE, the Cochrane Controlled Trials Register, Embase, and Wanfang Data was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions until 17 January 2025. Randomized controlled trials (RCTs) comparing dexmedetomidine with a placebo for the prevention of CPSP were included. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Data were extracted independently by two researchers. A random-effects meta-analysis model was used to report pooled treatment effects and 95% confidence intervals (CIs). The primary outcome was CPSP incidence post-surgery. Secondary outcome was CPSP intensity post-surgery. RESULTS: Twenty-three RCTs involving 1979 patients were analyzed. Compared to controls, perioperative dexmedetomidine administration appeared to reduce CPSP rates at 3 months [odds ratio (OR), 0.35; 95% CI, 0.23-0.54; P < 0.00001] and 6 months (OR, 0.28; 95% CI, 0.18-0.42; P < 0.00001), and 12 months (OR, 0.11; 95% CI, 0.03-0.43; P = 0.001). Both intravenous (IV) and perineural dexmedetomidine reduced CPSP occurrence at 3 months (IV administration, OR, 0.41; 95% CI, 0.25-0.67; P = 0.003; perineural administration, OR, 0.26; 95% CI, 0.11-0.60; P = 0.001) and 6 months (IV administration, OR, 0.26; 95% CI, 0.16-0.41; P < 0.00001; perineural administration, OR, 0.35; 95% CI, 0.14-0.90; P = 0.03). IV dexmedetomidine reduced CPSP occurrence at 12 months (OR, 0.11; 95% CI, 0.03-0.43; P = 0.001). In addition, dexmedetomidine reduces chronic pain severity at 6 months (mean difference, -0.91; 95% CI, -1.17 to -0.64; P < 0.00001). Perioperative dexmedetomidine use was associated with an increased incidence of bradycardia (OR, 3.35; 95% CI, 1.15-9.81; P = 0.03) but did not result in hypotension (OR, 1.37; 95% CI, 0.57-3.27; P = 0.48). CONCLUSIONS: This systematic review and meta-analysis found that perioperative dexmedetomidine effectively reduces the occurrence of CPSP in surgical patients and serves as a valuable adjunct to standard analgesic regimens in surgery.