Intravenous dexmedetomidine and its effects on remifentanil-induced hyperalgesia and opioid consumption: A systematic review and meta-analysis of randomized controlled trials.

STUDY

OBJECTIVE

To evaluate the efficacy of dexmedetomidine in reducing remifentanil-induced hyperalgesia (RIH) and its potential implications for acute opioid tolerance (AOT) in the adult surgical population.

DESIGN

Systematic review and meta-analysis.

SETTING

Perioperative setting.

PATIENTS: Thirteen randomized controlled trials (RCTs) including 803 patients.

INTERVENTIONS: Intravenous dexmedetomidine.

MEASUREMENTS: A comprehensive systematic search of PubMed, Embase, and Scopus was performed from their inception through September 2024 to identify RCTs assessing the effectiveness of dexmedetomidine in preventing RIH or AOT in the adult surgical population. Outcomes included time to first rescue analgesia, hyperalgesia incidence, opioid consumption, pain scores, and dexmedetomidine-related adverse events.

MAIN

RESULTS

Dexmedetomidine significantly prolonged the time to first rescue analgesia (mean difference [MD] 46.08 min, 95% CI 30.52 to 61.65, p < 0.00001) and reduced opioid consumption in the postoperative anesthesia care unit (PACU) and at 24 h postoperatively. Pain scores in PACU and up to 24 h were significantly lower with dexmedetomidine. Dexmedetomidine also exhibited a moderate protective effect against primary hyperalgesia but was associated with a greater incidence of intraoperative bradycardia.

CONCLUSIONS

Dexmedetomidine may mitigate RIH and, indirectly, aspects of AOT as suggested through surrogate outcomes such as opioid consumption and pain scores. However, significant heterogeneity limits certainty. While dexmedetomidine appears promising as an adjunct to remifentanil, careful monitoring for bradycardia is warranted. Further research should define optimal dosing strategies and clarify its role in preventing AOT.