In the presence of the worldwide opioid crisis, the use of opioid alternatives offers an opportunity to reduce opioid exposure during and after surgery. However, opioids should not be avoided at all costs and the use of alternatives should be guided by rigorous research and improvement in outcomes that are important for patients (patient-centered). Dexmedetomidine was identified as a promising alternative that could improve patient-centered outcomes after surgery.
Goal
The net benefits of dexmedetomidine on the quality of recovery and pain relief after surgery remain uncertain. Dr Verret and his team wanted to evaluate the effectiveness of this new medication for adult patients requiring surgery under general anaesthesia.
Methodology
The research team searched five databases for all the trials that have been done to compare the use of dexmedetomidine with placebo, opioids or usual care during surgery. The patient-centered outcomes of interest included: well-being, function, satisfaction, quality of life, life impact, long-term opioid use, opioid-related adverse effects, acute pain and chronic pain following surgery. These outcomes were also thought to be important by a panel of patient partners and clinicians that participated in creating the study protocol. The team looked at the (1) study design characteristics, (2) study methods, (3) patient eligibility criteria, (4) the type of anaesthesia and (5) analgesia, (6) pain intensity associated with the procedure and (7) the source of funding. Researchers then conducted an analyses called ‘ random-effects Bayesian meta-analysis’ which allows to synthesize the evidence available regarding the effectiveness of dexmedetomidine as well as the clinical importance of the findings.
Main findings
In this study, scientists looked at 44 other studies combining 5 904 participants and found that using dexmedetomidine during surgery likely improves meaningfully the quality of recovery after surgery in adults. Lower certainty of evidence also showed that using dexmedetomidine may improve chronic pain after surgery, sleep quality and delirium incidence. However, using dexmedetomidine can increase the risk of hypotension and slow heart rate with a minimal impact.
Take home message
Opioids are known to have multiple adverse effects and clinicians and researchers are trying to find different alternatives to manage pain, either occurring during surgery or after surgery. In this case, researchers found a drug that may be used as an alternative to opioids during a surgery that requires general anaesthesia. Further high-quality trials are needed to conform these findings.
