Safety and Efficacy of Dexmedetomidine in Breast Surgeries: A Systematic Review and Meta-Analysis

J Perianesth Nurs. 2021 Apr;36(2):179-186. doi: 10.1016/j.jopan.2020.09.011. Epub 2020 Dec 7.


Purpose: Pain control during and after breast surgery is still a challenging task. Dexmedetomidine (DEX) is considered as a sedative agent that is widely used perineurally or intravenously as an adjuvant in general anesthesia and critical care medicine practice. The aim of this study is to evaluate the efficacy of perineural DEX and intravenous (IV) DEX and their effects on postoperative complications in breast surgeries.

Design: Systematic review and meta-analysis.

Methods: The present study systematically reviewed all identified randomized controlled trials for efficacy and safety of IV and perineural use of DEX in breast surgeries. Databases were searched for articles published before October 2019.

Findings: Twelve trials were identified including 803 patients undergoing breast surgery. Although administration of IV DEX and its use with pectoral nerve (Pecs) block significantly postponed time for first analgesic request and decreased pain score at 1 and 12 hours after surgery, paravertebral use of DEX had no statistically significant effect. Pooled data about perineural DEX showed no significant effect on postoperative nausea and vomiting (PONV), whereas IV DEX significantly reduced PONV. Pooled analysis also showed that DEX administration did not significantly affect postoperative complications, such as postoperative itching, bradycardia, and pneumothorax in patients undergoing breast surgery.

Conclusions: The results showed that unlike paravertebral DEX, both DEX use with Pecs blocks and IV DEX were effective in control of postoperative pain in patients undergoing breast surgeries. Unlike perineural DEX, IV DEX significantly reduced PONV.

Keywords: Pecs block; adrenergic alpha-2 receptor agonists; paravertebral block; radical mastectomy.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Dexmedetomidine*
  • Humans
  • Hypnotics and Sedatives
  • Pain Management
  • Pain, Postoperative / drug therapy
  • Postoperative Nausea and Vomiting


  • Hypnotics and Sedatives
  • Dexmedetomidine