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Minerva Anestesiologica 2021 Sep 16

DOI: 10.23736/S0375-9393.21.15773-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

The effect of perioperative dexmedetomidine on postoperative bowel function recovery in adult patients receiving general anaesthesia: a systematic review and meta-analysis of randomised controlled trials

Bikram K. BEHERA 1, Satyajeet MISRA 1 , Sritam S. JENA 1, Chitta R. MOHANTY 2

1 Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India; 2 Department of Trauma & Emergency Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India



INTRODUCTION: Dexmedetomidine has opioid sparing actions but its effect on bowel recovery is controversial. Primary aim of this review was to evaluate the effect of perioperative dexmedetomidine on postoperative bowel recovery. Secondary aim was to evaluate the effect of dexmedetomidine on hospital discharge.
EVIDENCE ACQUISITION: Randomised controlled trials in English language reporting any or all of the following parameters of bowel recovery; time to first bowel sounds, first flatus, first faeces, or time to oral diet were included.
EVIDENCE SYNTHESIS: Twelve hundred and thirty-five patients from 13 studies were analysed. There were insufficient studies evaluating bowel sounds. Perioperative dexmedetomidine usage significantly reduced the time to first flatus [MD -5.61 hours (95% CI -8.61 to -2.60); P = 0.0003; I2 = 95%], first faeces [MD -12.70 hours (95% CI -19.11 to -6.29); P = 0.0001; I2 = 76%] and the composite outcome of bowel recovery (flatus, faeces, oral diet) [MD -7.44 hours (95% CI -10.31 to -4.57); P < 0.00001; I2 = 96%]. No difference was seen in the time to oral diet [MD -6.29 hours (95% CI -13.48 to 0.91); P = 0.09; I2 = 88%] or hospital discharge [MD -0.47 days (95% CI -1.27 to 0.33); P = 0.25; I2 = 86%].
CONCLUSIONS: Perioperative dexmedetomidine usage significantly shortens the time to first flatus, faeces and composite bowel recovery but does not result in a shorter time to oral diet or earlier hospital discharge in adult patients receiving general anaesthesia. Strength of evidence is however very low for the effect of dexmedetomidine on bowel recovery.


KEY WORDS: Bowel recovery; Dexmedetomidine; Gastro-intestinal recovery; Postoperative ileus

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