TDNet Discover

Background: Effective antiemetic treatment is essential in reducing postoperative nausea and vomiting (PONV), but the clinical implication of PONV increases the length of hospital stay and healthcare resource utilization. Purpose: To determine the efficacy of dexmedetomidine (DEX), used as an adjuvant treatment in reducing PONV for laparoscopic surgery. Methods: A comprehensive literature review was conducted, followed by a systematic analysis of three databases and one search engine from January 2018 to October 2023. On May 26, 2024, another literature search was complete to ensure most recent data was captured and no additional studies were found. The primary objective was to identify randomized controlled trials (RCTs) that compared the administration of DEX during laparoscopic procedures. To ensure the credibility and validity of the findings, the Critical Appraisal Skills Programme (CASP) checklist was employed to evaluate and mitigate any potential risk of bias in the studies. Results: A total of 8 randomized control trials comprising 1,129 participants undergoing laparoscopic gynecological hysterectomy, cholecystectomy, or bariatric surgeries were included in the analysis: 409 subjects received varying doses of DEX during the preoperative, perioperative, or postoperative phase with doses ranging from 0.4 mcg/kg to 1mcg/kg. The incidence of PONV was significantly reduced with DEX compared to the placebo group receiving normal saline. DEX results were similar to subject groups that received ondansetron, dexamethasone, or other antiemetic medications. Conclusions: DEX effectively decreased the early incidence of PONV following laparoscopic surgery. DEX, used adjunctively with concurrent antiemetics, further reduces PONV incidence. However, further research is needed to determine a standardized dose and identify optimal timing of administration of DEX utilizing a multimodal approach to establish a recommended guideline practice for PONV management in laparoscopic surgeries.