Dexmedetomidine as an adjuvant to ropivacaine for regional anesthesia in video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) is associated with significant postoperative pain. This systematic review and meta-analysis evaluated the effectiveness and safety of perineural dexmedetomidine (50 µg-1 µg/kg) combined with ropivacaine (0.375-0.5%) via ultrasound-guided nerve blocks (ESPB, TPVB, or RISSP) versus ropivacaine alone in VATS. METHODOLOGY: PRISMA guidelines were followed; the protocol was registered in PROSPERO (CRD420251086914). PubMed and Cochrane Library were searched to July 2025; data were pooled using RevMan 5.4.1. RESULTS: = 468) were included. Dexmedetomidine significantly reduced pain at rest at 12 hours (SMD -0.52, 95% CI - 0.94 to -0.09), 24 hours (SMD -0.65, 95% CI - 0.98 to -0.32), and 48 hours (SMD -0.37, 95% CI - 0.68 to -0.05). Pain during coughing was reduced at 12 hours (SMD -0.73, 95% CI - 1.21 to -0.24) and 24 hours (SMD -0.57, 95% CI - 0.84 to -0.30). PCA pressing times (SMD -1.25, 95% CI - 1.79 to -0.71), hospital stay (MD - 1.12 days, 95% CI - 1.58 to -0.66), and ambulation time were significantly lower. PONV incidence was reduced (RR 0.61, 95% CI 0.38-0.98). No significant differences were observed for dizziness, bradycardia, or hypotension. CONCLUSION: The www.crd.york.ac.uk/prospero identifier is CRD420251086914.