Preoperative Oral Clonidine Enhances Surgical Field Quality During Endoscopic Sinus Surgery: A Systematic Review and Meta-Analysis With Trial Sequential Analysis.

Background: Various interventions have been proposed to enhance surgical field quality during endoscopic sinus surgery (ESS). This study evaluates whether preoperative oral clonidine enhances surgical field quality during ESS.

Methods: PubMed, Scopus, Web of Science, Embase, and CENTRAL databases were searched. Eligible randomized controlled trials (RCTs) were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcome was surgical field quality. Secondary outcomes included intraoperative blood loss (IBL), operative duration, mean arterial pressure (MAP), heart rate (HR), surgeon satisfaction score, and postoperative complications (i.e., nausea and vomiting, bradycardia, and hypotension). Outcomes were pooled as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Trial sequential analysis (TSA) was also performed.

Results: Eight RCTs involving 597 patients were included. Preoperative oral clonidine significantly enhanced surgical field quality (MD = -0.65, 95% CI: -0.92, -0.37) and reduced IBL (MD = -44.67 mL, 95% CI: -62.03, -27.32), operative duration (MD = -11.64 min, 95% CI: -22.25, -1.04), MAP (MD = -10.36 mmHg, 95% CI: -18.03, -2.69), and HR (MD = -10.16 bpm, 95% CI: -17.62, -2.70). It was also associated with a significantly higher surgeon satisfaction score (p = 0.01) and comparable rates of postoperative complications (p > 0.05). TSA confirmed conclusive evidence for all outcomes except operative duration.

Conclusion: Preoperative oral clonidine shows potential in enhancing surgical field quality, reducing IBL, MAP, and HR, and enhancing surgeon satisfaction during ESS, without increasing postoperative complications. Its potential to reduce operative duration requires cautious interpretation.