Dexmedetomidine Effective in Decreasing Pain after Tonsillectomy

What are the effects of perioperative dexmedetomidine as an adjuvant to tonsillectomy compared with opioid or sham in children?

Bottom Line
Perioperative administration of dexmedetomidine can provide pain and agitation relief without side effects in children undergoing adenotonsillectomy.

Background: Tonsillectomy is one of the most common surgical procedures performed in children under general anesthesia. However, many patients suffer from postoperative problems such as emergence agitation (EA) and pain. Emergence agitation presents as combative movements, excitability, thrashing, disorientation, and inconsolable crying during recovery and is encountered in up to 80% of children who have received inhalational anesthetics. Dexmedetomidine, an alpha-2 adrenoceptor agonist, has sympatholytic, sedative, anesthetic, and algesic effects and, recently, has been used in pediatrics as a premedication, a sedation agent, an adjunct to inhaled anesthetic agents, and a drug for both prophylaxis and treatment of EA. Evidence in the existing literature is insufficient to fully support the its use in children.

Study design: Five databases (PubMed, SCOPUS, Embase, Web of Science, and Cochrane Central Register of Controlled Trials) were searched.

Synopsis: Prospective, randomized controlled studies that compared outcomes between children who underwent tonsillectomy plus dexmedetomidine administration (intervention) and children who underwent tonsillectomy with placebo or opioid (control) were reviewed. The outcomes of interest were emergence agitation, postoperative pain intensity, rescue analgesic consumption, and other morbidities. Fifteen studies with a total of 1,552 participants met the inclusion criteria. Postoperative pain scores and the need for analgesics in the postanesthesia care unit (PACU) were significantly decreased in the dexmedetomidine group versus the control group. The incidence and degree of agitation and desaturation incidence in the PACU also were significantly lower in the dexmedetomidine group. In subgroup analyses, dexmedetomidine was shown to be effective at reducing postoperative morbidities regardless of administration method.

Citation: Cho HK, Yoon HY, Jin HJ, Hwang SH. Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: a meta-analysis. Laryngoscope. 2018;128:E184–E193