Effectiveness of dexmedetomidine during surgery under general anaesthesia on patient-centred outcomes: a systematic review and Bayesian meta-analysis protocol

Abstract

IntroductionDexmedetomidine is a promising pharmaceutical strategy to minimise opioid use during surgery. Despite its growing use, it is uncertain whether dexmedetomidine can improve patient-centred outcomes such as quality of recovery and pain.Methods and analysisWe will conduct a systematic review and meta-analysis following the recommendations of theCochrane Handbook for Systematic Reviews. We will search MEDLINE, Embase, CENTRAL, Web of Science and CINAHL approximately in October 2023. We will include randomised controlled trials evaluating the impact of systemic intraoperative dexmedetomidine on patient-centred outcomes. Patient-centred outcome definition will be based on the consensus definition established by the Standardised Endpoints in Perioperative Medicine initiative (StEP-COMPAC). Our primary outcome will be the quality of recovery after surgery. Our secondary outcomes will be patient well-being, function, health-related quality of life, life impact, multidimensional assessment of postoperative acute pain, chronic pain, persistent postoperative opioid use, opioid-related adverse events, hospital length of stay and adverse events. Two reviewers will independently screen and identify trials and extract data. We will evaluate the risk of bias of trials using the Cochrane Risk of Bias Tool (RoB 2.0). We will synthesise data using a random effects Bayesian model framework, estimating the probability of achieving a benefit and its clinical significance. We will assess statistical heterogeneity with the tau-squared and explore sources of heterogeneity with meta-regression. We have involved patient partners, clinicians, methodologists, and key partner organisations in the development of this protocol, and we plan to continue this collaboration throughout all phases of this systematic review.Ethics and disseminationOur systematic review does not require research ethics approval. It will help inform current clinical practice guidelines and guide development of future randomised controlled trials. The results will be disseminated in open-access peer-reviewed journals, presented at conferences and shared among collaborators and networks.PROSPERO registration numberCRD42023439896.

Assessing the clinical advantage of opioid-reduced anesthesia in thoracoscopic sympathectomy: A prospective randomized controlled trial

“…The trauma of sympathectomy was minimal, and the pain caused by this surgery was mild; thus, the application of dezocine could meet the requirements of intraoperative analgesia. DEX, a selective α2-adrenal receptor agonist that could activate corresponding receptors in the brain and spinal dorsal horn producing sedative and analgesic effects, has been widely used in perioperative adjuvant analgesic treatment [15] . In this study, patients in Group W received an infusion of DEX before anesthesia to reduce the excitability of the sympathetic nervous system, and there were no cases of tachycardia during the operation.…”