REVIEW Dexmedetomidine as a sedative and analgesic adjuvant in spine surgery: a systematic review and meta-analysis of randomized controlled trials Georgia G. Tsaousi 1 & Chryssa Pourzitaki 1 & Simone Aloisio 2 & Federico Bilotta 2 Received: 21 April 2018 /Accepted: 6 July 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose This systematic review and meta-analysis appraise the clinical evidence on efficacy and safety of dexmedetomidine (DEX), as a sedative and analgesic adjunct in adult patients undergoing spine surgery. Methods A database search was conducted to identify randomized clinical trials (RCTs) pertinent to the perioperative use of DEX in spine surgery. Sedative and analgesic efficacy of DEX constituted the primary outcomes, whilst the incidence of hemodynamic changes, quality of recovery and occurrence of adverse events served as secondary ones. Results Fifteen studies enrolling a total of 913 patients were selected for qualitative analysis, among which eight RCTs incor- porating a placebo comparison group were included in the meta-analysis. Most of the retrieved studies were of moderate to good quality and demonstrated an acceptable risk of bias. DEX-treated patients showed a significant reduction of both propofol [mean difference (MD), −214.47 mg; 95%CI, −253.16 to −175.78; P < 0.001] and morphine equivalents consumption both intraoper- atively and postoperatively (MD, −2.69; 95% CI, −3.05 to −2.33; P < 0.001 and MD, −4.36 mg; 95%CI, −6.93 to −1.79; P < 0.001, respectively) compared to those assigned to placebo. Postoperative nausea and vomiting incidence were comparable between DEX and placebo groups, whilst other adverse events were not consistently reported. Conclusions DEX emerges as an attractive alternative to standard sedative and analgesic modalities applied in spine surgery, by attaining a notable sedative and opioid-sparing effect, which goes with an enhanced safety profile. Yet, no definite conclusion can be drawn due to the considerable heterogeneity of available data. Trial registration PROSPERO CRD42015029537. Keywords Dexmedetomidine . Spine surgery . Sedative efficacy . Analgesic efficacy . PONV, adverse events Introduction Spinal surgery poses unique challenges concerning the provi- sion of optimum perioperative management. Intraoperative hemodynamic changes, blood loss, the requirement of aug- mented doses of anesthetics or potent opioids to suppress the hemodynamic responses evoked by noxious stimulation, and rapid awakening for early neurological assessment, constitute the most prominent intraoperative concerns during spinal pro- cedures [1–4]. Furthermore, spine surgeries are notorious for being painful and in high demand for adequate perioperative analgesia [3, 5]. As multiple pathways like nociceptive, in- flammatory, and neuropathic ones seem to be implicated in the occurrence of pain following major spine surgery, the ideal analgesic strategy for these procedures remains an intriguing issue, yet. Opioids have long been considered as a first-line choice analgesics but their increased consumption carries the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-018-2520-7) contains supplementary material, which is available to authorized users. * Georgia G. Tsaousi Chryssa Pourzitaki chpour@gmail.com Simone Aloisio simone.aloisio@libero.it Federico Bilotta bilotta@tiscali.it 1 Department of Anesthesiology and ICU, Faculty of Medicine, Aristotle University of Thessaloniki, Maiandrou 32, GR 54645 Thessaloniki, Greece 2 Department of Anesthesiology and ICU, University of Rome “La Sapienza”, Piazzale Aldo Moro 5, IT 00185 Rome, Italy European Journal of Clinical Pharmacology https://doi.org/10.1007/s00228-018-2520-7