Meta-Analysis

. 2024 Sep;133(3):615-627.

doi: 10.1016/j.bja.2024.06.007. Epub 2024 Jul 16.

Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis

Michael Verret¹, John B P Le², Manoj M Lalu³, Matthew S Jeffers⁴, Daniel I McIsaac³, Stuart G Nicholls⁵, Alexis F Turgeon⁶, Rashi Ramchandani⁷, Hongda Li⁸, Brian Hutton⁹, Fiona Zivkovic¹⁰, Megan Graham¹⁰, Maxime Lê¹⁰, Allison Geist¹⁰, Mélanie Bérubé¹¹, Katie O'Hearn¹², Ian Gilron¹³, Patricia Poulin¹⁴, Helena Daudt¹⁵, Guillaume Martel¹⁶, Jason McVicar¹⁷, Husein Moloo⁴, Dean A Fergusson¹⁸

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada. Electronic address: Michael.verret.med@ssss.gouv.qc.ca.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada.
⁷ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁸ MDCM, Faculty of Medicine and Health Science, McGill University, Montreal, QC, Canada.
⁹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Patient Partner, The Ottawa Hospital, Ottawa, ONT, Canada.
¹¹ Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada; Faculty of Nursing, Université Laval, Québec City, QC, Canada.
¹² Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
¹³ Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ONT, Canada.
¹⁴ Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa and The Ottawa Hospital Pain Clinic, Ottawa, ON, Canada.
¹⁵ Pain Canada, Pain BC, Vancouver, BC, Canada.
¹⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Royal Inland Hospital, Kamloops, BC, Canada.
¹⁸ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.

PMID: 39019769
PMCID: PMC11347795
DOI: 10.1016/j.bja.2024.06.007

Meta-Analysis

Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis

Michael Verret et al. Br J Anaesth. 2024 Sep.

. 2024 Sep;133(3):615-627.

doi: 10.1016/j.bja.2024.06.007. Epub 2024 Jul 16.

Authors

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada. Electronic address: Michael.verret.med@ssss.gouv.qc.ca.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, QC, Canada; Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, Canada.
⁷ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁸ MDCM, Faculty of Medicine and Health Science, McGill University, Montreal, QC, Canada.
⁹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Patient Partner, The Ottawa Hospital, Ottawa, ONT, Canada.
¹¹ Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), CHU de Québec - Université Laval Research Center, Québec City, QC, Canada; Quebec Pain Research Network, Sherbrooke, QC, Canada; Faculty of Nursing, Université Laval, Québec City, QC, Canada.
¹² Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
¹³ Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ONT, Canada.
¹⁴ Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Ottawa and The Ottawa Hospital Pain Clinic, Ottawa, ON, Canada.
¹⁵ Pain Canada, Pain BC, Vancouver, BC, Canada.
¹⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Royal Inland Hospital, Kamloops, BC, Canada.
¹⁸ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.

PMID: 39019769
PMCID: PMC11347795
DOI: 10.1016/j.bja.2024.06.007

Abstract

Background: Dexmedetomidine is increasingly used for surgical patients requiring general anaesthesia. However, its effectiveness on patient-centred outcomes remains uncertain. Our main objective was to evaluate the patient-centred effectiveness of intraoperative dexmedetomidine for adult patients requiring surgery under general anaesthesia.

Methods: We conducted a systematic search of MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL from inception to October 2023. Randomised controlled trials (RCTs) comparing intraoperative use of dexmedetomidine with placebo, opioid, or usual care in adult patients requiring surgery under general anaesthesia were included. Study selection, data extraction, and risk of bias assessment were performed by two reviewers independently. We synthesised data using a random-effects Bayesian regression framework to derive effect estimates and the probability of a clinically important effect. For continuous outcomes, we pooled instruments with similar constructs using standardised mean differences (SMDs) and converted SMDs and credible intervals (CrIs) to their original scale when appropriate. We assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our primary outcome was quality of recovery after surgery. To guide interpretation on the original scale, the Quality of Recovery-15 (QoR-15) instrument was used (range 0-150 points, minimally important difference [MID] of 6 points).

Results: We identified 49,069 citations, from which 44 RCTs involving 5904 participants were eligible. Intraoperative dexmedetomidine administration was associated with improvement in postoperative QoR-15 (mean difference 9, 95% CrI 4-14, n=21 RCTs, moderate certainty of evidence). We found 99% probability of any benefit and 88% probability of achieving the MID. There was a reduction in chronic pain incidence (odds ratio [OR] 0.42, 95% CrI 0.19-0.79, n=7 RCTs, low certainty of evidence). There was also increased risk of clinically significant hypotension (OR 1.98, 95% CrI 0.84-3.92, posterior probability of harm 94%, n=8 RCTs) and clinically significant bradycardia (OR 1.74, 95% CrI 0.93-3.34, posterior probability of harm 95%, n=10 RCTs), with very low certainty of evidence for both. There was limited evidence to inform other secondary patient-centred outcomes.

Conclusions: Compared with placebo or standard of care, intraoperative dexmedetomidine likely results in meaningful improvement in the quality of recovery and chronic pain after surgery. However, it might increase clinically important bradycardia and hypotension.

Systematic review protocol: PROSPERO (CRD42023439896).

Keywords: adult anaesthesia; chronic postsurgical pain; clinical pharmacology; dexmedetomidine; opioid minimisation strategies; pain management; patient-centred outcomes.

PubMed Disclaimer

Conflict of interest statement

IG has received consulting fees from GW Research, Eupraxia, Biogen, and Novaremed. The other authors have no conflict of interest to declare.

Figures

**Fig 1**
Flow diagram. RCT, randomised controlled trial.

**Fig 2**
Forest plot for quality of recovery outcome measure. The black vertical line indicates a null value (standardised mean difference = 0), and the grey dashed vertical line indicates the threshold for minimally important difference. A value above zero (right direction) favours dexmedetomidine. A value below zero (left direction) favours control. CrI, credible interval.

**Fig 3**
Forest plot showing meta-regression results for quality of recovery outcome measure. Blue dashed vertical line indicates a null value (standardised mean difference = 0). Values above zero (right direction) favours dexmedetomidine. Moderate/high pain intensity: mean pain intensity of 4 or more on a 10-point scale in the control group. Surgeries considered at high risk of chronic pain were as follows: mastectomy, thoracotomy, amputation, arthroplasty, Caesarean, cholecystectomy, craniotomy, hip replacement, inguinal hernia repair, spinal surgery, coronary artery bypass graft, trauma, and burn. CrI, credible interval; NS, not specified; RoB, risk of bias.

See this image and copyright information in PMC

References

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Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis

Affiliations

Effectiveness of dexmedetomidine on patient-centred outcomes in surgical patients: a systematic review and Bayesian meta-analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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LinkOut - more resources

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