Impact of intraoperative dexmedetomidine on postoperative outcomes in shoulder arthroscopy: a systematic review and meta-analysis

To evaluate the effectiveness and safety of dexmedetomidine in adult patients undergoing shoulder arthroscopy. A systematic search was conducted in PubMed, Embase, and the Cochrane Library along with a manual search of reference lists from previous systematic reviews and meta-analyses. We applied random effects and fixed effects models for the analysis of outcomes, depending on the level of heterogeneity observed. We assessed the risk of bias using version 2 of the Cochrane Risk of Bias tool (RoB 2) and conducted sensitivity analyses to examine the robustness of our results. Additionally, evidence quality was rated using the GRADE system, with studies categorized as high quality (level I), moderate quality (level II or III), or low quality (level IV). Eighteen randomized controlled trials involving 1,203 patients were included. Dexmedetomidine significantly reduced postoperative pain scores at 6 hours (SMD = –0.44, 95% CI –0.63 to –0.25) and 12 hours (SMD = –0.47, 95% CI –0.71 to –0.23) compared with those of the control groups. The incidence of PONV was also lower in the dexmedetomidine group (RR = 0.62, 95% CI 0.46–0.84). However, dexmedetomidine was associated with an increased risk of bradycardia (RR = 2.58, 95% CI 1.71–3.88) and hypotension (RR = 1.94, 95% CI 1.32–2.86). Although these findings should be interpreted with caution, as most studies reported these events without standardized definitions or severity grading. Dexmedetomidine appears to be effective at reducing postoperative pain and the incidence of nausea and vomiting following shoulder arthroscopy. Although the magnitude of pain reduction was modest, the effect was statistically significant and may still contribute to improved patient comfort and reduced opioid consumption when used as part of a multimodal analgesic regimen. Careful monitoring is recommended because of its potential hemodynamic effects, such as bradycardia and hypotension.