Abstract：
BACKGROUND: Craniotomy is associated with several undesirable effects including postoperative pain. This systematic review and meta-analysis aimed to evaluate evidence on the efficacy and safety of dexmedetomidine (DEX) for pain management in patients undergoing craniotomy.
METHODS: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in Open Science Framework. We searched for existing randomized controlled studies published before June 2023 that used DEX during the perioperative period in craniotomy in PubMed, Scopus, and the Cochrane Library. A meta-analysis was conducted in RevMan. Cochrane RoB2 and GRADE were used for quality assessment.
RESULTS: A total of 19 randomized controlled trials comprising 3153 patients were included. Pain intensity was lower in the DEX group than the control group at a mean difference [95% confidence interval] of -0.64 [-1.16, -0.13], P-value = 0.01. The DEX group overall consumed less opioids in comparison with the control group at a mean difference = -4.00 [-6.16, -1.83], P value = 0.0003. However, heterogeneity was considerable for both outcomes (I2 = 81% and I2 = 96%, respectively). There was no difference between the DEX and control groups in the time to first postanalgesic requirement, hypertension, hypotension, or cough.
CONCLUSIONS: The results showed that the use of DEX was associated with lower pain intensity and less opioid use. Patients in the DEX group experienced fewer episodes of nausea and vomiting, agitation, and shivering but more episodes of bradycardia. There was no difference between DEX and control groups in other adverse events.
METHODS: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was registered in Open Science Framework. We searched for existing randomized controlled studies published before June 2023 that used DEX during the perioperative period in craniotomy in PubMed, Scopus, and the Cochrane Library. A meta-analysis was conducted in RevMan. Cochrane RoB2 and GRADE were used for quality assessment.
RESULTS: A total of 19 randomized controlled trials comprising 3153 patients were included. Pain intensity was lower in the DEX group than the control group at a mean difference [95% confidence interval] of -0.64 [-1.16, -0.13], P-value = 0.01. The DEX group overall consumed less opioids in comparison with the control group at a mean difference = -4.00 [-6.16, -1.83], P value = 0.0003. However, heterogeneity was considerable for both outcomes (I2 = 81% and I2 = 96%, respectively). There was no difference between the DEX and control groups in the time to first postanalgesic requirement, hypertension, hypotension, or cough.
CONCLUSIONS: The results showed that the use of DEX was associated with lower pain intensity and less opioid use. Patients in the DEX group experienced fewer episodes of nausea and vomiting, agitation, and shivering but more episodes of bradycardia. There was no difference between DEX and control groups in other adverse events.
摘要：
背景：开颅手术与一些不良反应相关，包括术后疼痛。本系统评价和荟萃分析旨在评估右美托咪定（DEX）用于开颅手术患者疼痛管理的有效性和安全性的证据。
方法：我们遵循PRISMA指南。该协议已在开放科学框架中注册。我们搜索了2023年6月之前发表的现有随机对照研究（RCT），这些研究在PubMed的开颅手术围手术期使用右美托咪定，Scopus,还有Cochrane图书馆.在RevMan中进行了荟萃分析。CochraneRoB2和GRADE用于质量评估。
结果：共纳入19个RCTs，包括3,153名患者。DEX组的疼痛强度低于对照组，平均差（MD）[95％置信区间（CI）]为-0.64[-1.16，-0.13]，p值=0.01。在MD=-4.00[-6.16,-1.83]时，与对照组相比，DEX组总体消耗的阿片类药物较少，p值=0.0003。然而,两种结果的异质性都相当大(I2=81%，I2=96%，分别)。DEX组和对照组在首次镇痛后需要的时间上没有差异，高血压,低血压,或者咳嗽。
结论：结果显示，右美托咪定的使用与较低的疼痛强度和较少的阿片类药物使用相关。DEX组患者的恶心和呕吐发作较少，激动,颤抖，但更多的心动过缓发作。DEX组和对照组在其他不良事件方面没有差异。
方法：我们遵循PRISMA指南。该协议已在开放科学框架中注册。我们搜索了2023年6月之前发表的现有随机对照研究（RCT），这些研究在PubMed的开颅手术围手术期使用右美托咪定，Scopus,还有Cochrane图书馆.在RevMan中进行了荟萃分析。CochraneRoB2和GRADE用于质量评估。
结果：共纳入19个RCTs，包括3,153名患者。DEX组的疼痛强度低于对照组，平均差（MD）[95％置信区间（CI）]为-0.64[-1.16，-0.13]，p值=0.01。在MD=-4.00[-6.16,-1.83]时，与对照组相比，DEX组总体消耗的阿片类药物较少，p值=0.0003。然而,两种结果的异质性都相当大(I2=81%，I2=96%，分别)。DEX组和对照组在首次镇痛后需要的时间上没有差异，高血压,低血压,或者咳嗽。
结论：结果显示，右美托咪定的使用与较低的疼痛强度和较少的阿片类药物使用相关。DEX组患者的恶心和呕吐发作较少，激动,颤抖，但更多的心动过缓发作。DEX组和对照组在其他不良事件方面没有差异。
