title: Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis.
abstract: BACKGROUND
  Opioid-sparing analgesia for bariatric surgery in morbidly obese can potentially prevent catastrophic airway complications. Our meta-analysis attempts to consolidate the evidence on dexmedetomidine evaluating its analgesic and safety profile.
  
  
  METHODS
  Trails comparing perioperative dexmedetomidine infusion to conventional analgesic regimens for bariatric surgery were searched. Comparisons were made for 24-hour and postanesthesia care unit (PACU) morphine consumed, PACU pain scores, postoperative nausea and vomiting pain scores, and heartrate. Meta-regression was performed for length of stay to evaluate various analgesic control subgroups.
  
  
  RESULTS
  Six trials were included in the final analysis. Dexmedetomidine infusion (reported in 5 intraoperative subgroups and 2 postoperative subgroups) decreased 24-hour morphine by 18.13±6.11 mg (random effects: P<.001, I2= 95.48%). Despite the small number of included studies, the sample size for avoiding a false positive result was adequate as the trial sequential analysis found the present sample size (362) to be well past the required "sample size" (n = 312) for 85% power. Meta-regression for infusion dose on morphine consumption difference found a predictability of 49% (coefficient = 39.93, random-effects, Tau2= 396.08), and predictability of the model improved to 68% on inclusion of time of initiation of infusion. The dexmedetomidine group had lower PACU morphine consumption (by 6.91±1.19, I2= 34.37%), lower pain scores (scale of 0-10±2.27, I2= 88.14%), lower postoperative nausea and vomiting incidence (odds ratio =±0.26, I2= 0%), and lower heart rate (73.25 versus. 83.50) (mean difference =±10.15 I2= 94.04%). No adverse events were reported across trials.
  
  
  CONCLUSIONS
  Perioperative dexmedetomidine infusion in obese patients undergoing bariatric surgery is a promising and safe alternative. Both intraoperative or postoperative infusions lead to significant opioid sparing in early and extend postoperative recovery phase. Morbidly obese patients receiving perioperative dexmedetomidine infusions have overall better pain control and lower incidence of postoperative nausea-vomiting. All the aforementioned merits come with a stable hemodynamic profile and without any reported major adverse events.
authors.affiliation: Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India. Electronic address: Preetrajpal@gmail.com.
authors.forename: Preet Mohinder
authors.initials: PM
authors.lastname: Singh
authors.affiliation: Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Panwar
authors.affiliation: Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Borle
authors.affiliation: Department of Anesthesiology, Intensive Care and Reanimation, AZ Sint Jan Brugge-Oostende, Bruges, Belgium.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Mulier
authors.affiliation: Department of Anesthesiology, Temple University, Philadelphia, PA, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Hospital of the University of Pennsylvania and Perleman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Basavana
authors.initials: B
authors.lastname: Goudra
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D009020:Morphine / Q000008:administration & dosage; D009767:Obesity, Morbid / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D016032:Randomized Controlled Trials as Topic
chemical_list: D018712:Analgesics, Non-Narcotic; D020927:Dexmedetomidine; D009020:Morphine
keywords: Dexmedetomidine in bariatric surgery; Dexmedetomidine in morbidly obese; Opioid sparing analgesia