The effect of perioperative dexmedetomidine on postoperative bowel function recovery in adult patients receiving general anesthesia.

Background: 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: Randomized controlled trials in English language reporting any or all of the following parameters of bowel recovery; time to first bowel sounds, first flatus, first feces, or time to oral diet were included.

Evidence Synthesis: Twelve hundred and thirty-five patients from 13 studies were analyzed. There were insufficient studies evaluating bowel sounds. Perioperative dexmedetomidine usage significantly reduced the time to first flatus [MD -5.61 h (95% CI: -8.61 to -2.60); P=0.0003; I=95%], first feces [MD -12.70 h (95% CI: -19.11 to -6.29); P=0.0001; I=76%] and the composite outcome of bowel recovery (flatus, feces, oral diet) [MD -7.44 h (95% CI: -10.31 to -4.57); P<0.00001; I=96%]. No difference was seen in the time to oral diet [MD -6.29 h (95% CI: -13.48 to 0.91); P=0.09; I=88%] or hospital discharge [MD -0.47 days (95% CI: -1.27 to 0.33); P=0.25; I=86%].

Conclusions: Perioperative dexmedetomidine usage significantly shortens the time to first flatus, feces and composite bowel recovery but does not result in a shorter time to oral diet or earlier hospital discharge in adult patients receiving general anesthesia. Strength of evidence is however very low for the effect of dexmedetomidine on bowel recovery.