Safety and Efficacy of Dexmedetomidine in Spinal Fusion: A Systematic Review and Meta-Analysis Dexmedetomidine in Spinal Fusion Surgery.

Abstract

Dexmedetomidine (DEX) has been proposed as an opioid-sparing adjunct after spinal fusion, but its efficacy across age groups is unclear. We conducted a systematic review and meta-analysis following PRISMA and registered in International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024531252). Twelve studies (RCTs and cohorts; n=1,644) were included. Outcomes were postoperative pain (VAS), opioid consumption, and adverse events. DEX significantly reduced postoperative nausea and vomiting (OR 0.55; 95% CI 0.39-0.77) and respiratory adverse events (OR 0.13; 95% CI 0.04-0.39). Among adults, effects on VAS and opioid consumption were not significant; pediatric cohorts showed a trend toward lower morphine use. Certainty of evidence was appraised with GRADE; risk of bias with RoB 2.0 and MINORS. Heterogeneity for opioid-related outcomes was high (I²=96%). In summary, DEX appears to be a safe adjunct for postoperative analgesia after spinal fusion, with clearer benefits on adverse-effect profiles and potential opioid-sparing effects in pediatric patients. Its impact on adult pain and opioid outcomes is limited. Further adequately powered trials should clarify optimal dosing, timing, and administration routes and explore age-specific effects.