Dexmedetomidine is increasingly used to improve perioperative stability and analgesia in thyroid surgery; however, the overall evidence regarding its efficacy and safety remains uncertain. This study evaluates whether perioperative dexmedetomidine infusion is effective and safe in patients undergoing thyroid surgery. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using PubMed, Scopus, Web of Science, Embase, and CENTRAL databases. Eligible RCTs were assessed for quality using the RoB-2 tool. The evaluated outcomes included perioperative hemodynamic parameters (i.e., mean arterial pressure (MAP), heart rate (HR)), recovery characteristics (i.e., extubation, awakening times), postoperative pain intensity, rescue analgesic requirements, length of stay (i.e., hospital, post-anesthesia care unit (PACU)), and adverse events. Outcomes were pooled as mean differences (MDs), standardized mean differences (SMDs), or risk ratios (RRs) with 95% confidence intervals (CIs). A total of 10 RCTs involving 863 patients were analyzed. No significant differences were observed in anesthesia or surgical duration. Dexmedetomidine was associated with longer extubation and awakening times. Moreover, dexmedetomidine significantly reduced MAP and HR before, during, and after extubation. Postoperative pain scores were reduced at early postoperative time points (1–2, 3–4, 6–8, and 24 h), with reduced rescue analgesia requirements. No significant differences were found in PACU or hospital length of stay. Dexmedetomidine also reduced the incidence of cough and PONV. In terms of safety, dexmedetomidine increased the risk of hypotension, while the incidence of bradycardia was not significantly different between groups. Dexmedetomidine may improve intraoperative hemodynamic stability and reduce the incidence of emergence coughing and PONV. However, findings regarding its early postoperative analgesic benefits must be interpreted cautiously due to the low certainty of current evidence. These potential benefits should be carefully weighed against observed trade-offs, including mild delays in early clinical recovery and an increased risk of transient hypotension. ID: CRD420261308862.
Albazee et al. (Tue,) studied this question.