Dexmedetomidine in Perioperative Pain Management: A Systematic Review of Analgesic Efficacy, Safety, and Clinical Applications

Introduction: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist with sedative, analgesic, anxiolytic, and anti-shivering properties. Its opioid-sparing effect, minimal respiratory depression, and potential neuroprotective benefits have led to its increasing use across perioperative and critical care settings. This review aims to evaluate recent evidence on the analgesic efficacy, safety, and clinical applications of dexmedetomidine. Methodology: A systematic literature search was performed using PubMed and Google Scholar databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published in English between January 1, 2015, and June 30, 2025, involving human subjects and reporting clinical results were included. Case reports, reviews, animal studies, and non-English publications were excluded. Results: Dexmedetomidine was associated with significant reductions in postoperative pain scores, opioid consumption, and improved analgesic duration across various surgeries, including esophageal endoscopic submucosal dissection (ESD), transurethral resection of the prostate (TURP), shoulder arthroscopy, and total knee arthroplasty (TKA). Pediatric and elderly populations tolerated it well, with minimal respiratory compromise. It prolonged the sensory block duration in spinal anesthesia and enhanced regional anesthesia outcomes. Notably, it improved patient recovery by reducing nausea, agitation, and intensive care unit (ICU) stay. However, dose-dependent bradycardia and hypotension were recurrent findings, emphasizing the need for hemodynamic monitoring. Conclusion: Dexmedetomidine offers effective, opioid-sparing analgesia and improved perioperative recovery across diverse patient populations. Its safety profile is favorable when dosing is optimized, and cardiovascular parameters are closely monitored. While evidence supports its short-term perioperative benefits, further research is warranted to explore standardized dosing protocols, long-term outcomes, and its potential role in chronic pain management.