Analgesic Efficacy of Remifentanil Versus Dexmedetomidine in Patients Undergoing Bariatric and Metabolic Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Obese patients undergoing bariatric and metabolic surgeries require tailored perioperative pain management. This review aimed to compare the analgesic efficacy and safety of two adjuncts used in general anesthesia (GA), remifentanil and dexmedetomidine, in this patient population. Using relevant keywords, we searched PubMed, Scopus, the Cochrane Library, and ClinicalTrials.gov, identifying five randomized controlled trials for a qualitative systematic review and quantitative meta-analysis. The RoB 2 tool was used to assess the risk of bias, and the meta-analysis was conducted using RevMan version 5.4. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was employed to evaluate the overall quality of evidence. Trial Sequential Analysis (TSA) was used to confirm significant findings. The overall risk of bias was low, and the GRADE quality ranged from moderate to low. Twenty-four-hour opioid consumption and pain scores in the recovery room were comparable between the two groups (mean difference (MD): 0.23; 95% CI: -1.42 to 1.89, P = 0.78; and MD: 0.04; 95% CI: -0.48 to 0.57, P = 0.87, respectively). Postoperative nausea and vomiting (PONV) was significantly lower in the dexmedetomidine group (OR: 2.55; 95% CI: 1.60 to 4.07, P < 0.0001), a finding confirmed by TSA. However, the cumulative sample size represented only 82.5% of the required information size. Overall heterogeneity was low to moderate. Based on the findings of this review, analgesic efficacy, measured by 24-hour opioid consumption and recovery room pain scores, appears comparable between remifentanil and dexmedetomidine. However, the incidence of PONV was significantly lower in the dexmedetomidine group. Further studies are warranted to identify the most suitable adjunct to GA in this high-risk patient population.