Research Safety and Efficacy of Dexmedetomidine in Breast Surgeries: A Systematic Review and Meta-Analysis Ehsan Motaghi, PhD a , Masumeh Ghasemi Pirbalooti, MSC b , Hooman Bozorgi, PhD c, * , Majid Eslami, PhD d , Mohsen Rashidi, PhD e a Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran b Department of Immunology, Shahrekord University of Medical Science, Shahrekord, Iran c Department of Pharmacology, Research Center of Physiology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran d Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran e Faculty of Medicine, Department of Pharmacology, Mazandaran University of Medical Sciences, Sari, Iran Keywords: adrenergic alpha-2 receptor agonists radical mastectomy paravertebral block Pecs block abstract Purpose: Pain control during and after breast surgery is still a challenging task. Dexmedetomidine (DEX) is considered as a sedative agent that is widely used perineurally or intravenously as an adjuvant in general anesthesia and critical care medicine practice. The aim of this study is to evaluate the efficacy of perineural DEX and intravenous (IV) DEX and their effects on postoperative complications in breast surgeries. Design: Systematic review and meta-analysis. Methods: The present study systematically reviewed all identified randomized controlled trials for ef- ficacy and safety of IV and perineural use of DEX in breast surgeries. Databases were searched for articles published before October 2019. Findings: Twelve trials were identified including 803 patients undergoing breast surgery. Although administration of IV DEX and its use with pectoral nerve (Pecs) block significantly postponed time for first analgesic request and decreased pain score at 1 and 12 hours after surgery, paravertebral use of DEX had no statistically significant effect. Pooled data about perineural DEX showed no significant effect on postoperative nausea and vomiting (PONV), whereas IV DEX significantly reduced PONV. Pooled analysis also showed that DEX administration did not significantly affect postoperative com- plications, such as postoperative itching, bradycardia, and pneumothorax in patients undergoing breast surgery. Conclusions: The results showed that unlike paravertebral DEX, both DEX use with Pecs blocks and IV DEX were effective in control of postoperative pain in patients undergoing breast surgeries. Unlike perineural DEX, IV DEX significantly reduced PONV. © 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved. Breast surgery is a rapidly evolving procedure, but its analgesic management remains a challenge for the surgical team. The oper- ation is indicated mainly in women who suffer from breast cancer as the most common malignancy in women worldwide. 1 However, most patients undergoing breast surgery complain of acute post- operative pain. 2,3 This complication leads to patient discomfort, extended postanesthesia care unit stays, prolonged hospital ad- missions, and additional costs. Furthermore, acute postoperative pain after breast surgery is a significant risk factor for development of chronic postoperative pain. 4 Therefore, good perioperative analgesia is essential for the patients. Some methods of pain con- trol, such as wound infiltration of local anesthetics (LAs), improved pain scores for no longer than 1 hour after surgery. 5 In addition, use of opioids for perioperative analgesia is commonly associated with side effects, involving dependency and addiction. 6 There has been much investigation into the use of nonopioids to improve pain control while minimizing opioid-related side effects, such as res- piratory depression, nausea, and vomiting. Conflict of interest: None to report. * Address correspondence to Hooman Bozorgi, Department of Pharmacology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran 35198- 99951 E-mail address: hoomanbozorgi100@gmail.com (H. Bozorgi). Contents lists available at ScienceDirect Journal of PeriAnesthesia Nursing journal homepage: www.jopan.org https://doi.org/10.1016/j.jopan.2020.09.011 1089-9472/© 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved. Journal of PeriAnesthesia Nursing xxx (xxxx) xxx Please cite this article as: E. Motaghi, M. Ghasemi Pirbalooti, H. Bozorgi et al., Safety and Efficacy of Dexmedetomidine in Breast Surgeries: A Systematic Review and Meta-Analysis, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/j.jopan.2020.09.011