Comparative Efficacy of Dexmedetomidine and Remifentanil in Reducing Postoperative Pain and Opioid Use: A Systematic Review.

Postoperative pain management is a critical component of patient care following surgical procedures. Opioid analgesics, particularly Remifentanil, have been traditionally used to manage pain, but these drugs come with significant risks, including opioid-induced hyperalgesia (OIH) and the potential for dependence on opioids. Dexmedetomidine, an alpha-2 adrenergic receptor agonist, is a promising non-opioid alternative. This systematic review aims to compare the efficacy of Dexmedetomidine and Remifentanil in reducing postoperative pain and opioid use, as well as to evaluate their safety profiles. A systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing PubMed and ClinicalTrials.gov. The findings revealed that both agents provided effective intraoperative analgesia. However, Dexmedetomidine consistently outperformed Remifentanil in reducing postoperative pain and opioid consumption. Additionally, Dexmedetomidine was associated with lower pain scores in the immediate postoperative period, particularly in spinal and gynecological surgeries. Despite its advantages in pain control and opioid-sparing effects, Dexmedetomidine was associated with slower recovery times, such as delayed eye-opening and longer extubation periods. In contrast, Remifentanil, with its rapid onset and offset, facilitated quicker recovery but resulted in increased postoperative opioid requirements and a higher incidence of OIH. Dexmedetomidine's side effects include bradycardia and hypotension, which were generally manageable and less severe than those associated with Remifentanil. Dexmedetomidine represents a promising alternative to Remifentanil for postoperative pain management. Its ability to reduce opioid consumption and mitigate the risk of OIH makes it an attractive option, particularly in patients at risk for opioid misuse or dependency. Nevertheless, further large-scale studies with diverse patient populations are needed to confirm these findings and refine the optimal dosing regimens for Dexmedetomidine.