title: Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Aim of the current meta-analysis was to assess the effects of intraoperative dexmedetomidine on postoperative pain, analgesic consumption, and adverse events in comparison with placebo or opioids in children undergoing surgery.
  
  
  METHODS
  This meta-analysis was performed according to the recommendations of the PRISMA statement and the Cochrane collaboration. For dichotomous and continuous outcomes of efficacy and adverse events, the Revman(®) (The Nordic Cochrane Centre, Copenhagen, Denmark) statistical software was used to calculate relative risk (RR), mean difference (MD), and 95% confidence intervals (CI).
  
  
  RESULTS
  We included 11 randomized controlled trials - 434 children received dexmedetomidine, 440 received control. In comparison with placebo, children receiving dexmedetomidine showed a reduced RR for postoperative opioids (0.4; 95% CI: 0.26-0.62; P < 0.00001) and postoperative pain (0.51; 95% CI: 0.32-0.81; P = 0.004). Similar results were obtained for the comparison with intraoperative opioids: reduced RR for postoperative pain (0.49; 95% CI: 0.25-0.94; P = 0.03) and the need for postoperative opioids (0.77; 95% CI: 0.60-1.09; P = 0.05).
  
  
  CONCLUSIONS
  This meta-analysis revealed a lower risk for postoperative pain and the need for postoperative opioids following intraoperative dexmedetomidine in comparison with placebo or opioids in children undergoing surgery; however, the influence of dexmedetomidine on postoperative opioid consumption is less clear. Although there were only a limited number of adverse events, further studies focusing on procedure specific dexmedetomidine dosing and adverse events are urgently needed.
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital of Münster, Albert-Schweitzer-Campus 1, Münster, Germany. alexander_schnabel@gmx.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Schnabel
authors.forename: Sylvia U
authors.initials: SU
authors.lastname: Reichl
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Poepping
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
authors.forename: Esther M
authors.initials: EM
authors.lastname: Pogatzki-Zahn
authors.forename: Peter K
authors.initials: PK
authors.lastname: Zahn
mesh_terms: D060666:Airway Extubation; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects* / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003422:Critical Care; D020927:Dexmedetomidine / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D010149:Postoperative Pain / Q000188:drug therapy*; D011595:Psychomotor Agitation / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D020927:Dexmedetomidine