A commentary on “Dexmedetomidine for the prevention of chronic postsurgical pain: a systematic review and meta-analysis”

Dear Editor, We have carefully read the article named “Dexmedetomidine for the Prevention of Chronic Postsurgical Pain: A Systematic Review and Meta-Analysis” published online on 24 October 2025[1]. The article pooling analyzed 23 randomized controlled trials involving multiple surgical procedures, indicating dexmedetomidine administered intravenously or perineurally decreased the incidence of CPSP and attenuate pain intensity at 3 and 6 months postoperatively. The study also indicated that perioperative dexmedetomidine was associated with an increased risk of bradycardia (OR = 3.35, P = 0.03), but did not increase the risk of hypotension. Additionally, we confirm that this work was prepared in accordance with the TITAN guidelines, and the completed checklist has been submitted[2]. However, the key question remains how these findings can be translated into routine clinical practice. The dose and administration timing relative to surgery of the included trial in this article were heterogeneous, and were conducted within different enhanced recovery pathways. Such variability makes it challenging for clinicians to determine whether the observed benefits represent a drug-specific effect or context-dependent responses tied to particular perioperative protocols. Consequently, anesthesiologists may remain uncertain regarding which dexmedetomidine regimen is most appropriate when integrating it into existing multimodal, largely non-opioid–based analgesic strategies for CPSP prevention[3]. Rather than conducting further trials that simply compare “any dexmedetomidine” against a control, future research should aim to identify a limited number of clearly defined, clinically feasible regimens. For example, pragmatic or adaptive studies embedded within standardized enhanced recovery protocols could compare low-dose versus moderate-dose intravenous infusions, with or without regional techniques, while evaluating not only CPSP incidence but also perioperative opioid requirements, recovery trajectories, and resource use[4,5]. Such an approach would more accurately reflect real-world decision-making and help clinicians balance incremental benefits in pain prevention against recognized hemodynamic effects, particularly bradycardia. Importantly, it may also clarify whether dose-dependent cardiovascular effects constrain the practicality of higher-dose or prolonged dexmedetomidine regimens. Moreover, patients increasingly evaluate the success of perioperative care based on outcomes such as functional recovery, sleep quality, and return to usual activities. In line with this perspective, aligning CPSP studies of dexmedetomidine with core outcome domains recommended for chronic pain – such as health-related quality of life[6] – and routinely incorporating validated outcome reporting tools could enhance the patient-centered relevance of this literature. Standardizing outcome definitions would further facilitate comparisons across regimens and help identify which dexmedetomidine strategies deliver meaningful improvements beyond pain reduction alone. In summary, Ma et al are to be commended for their comprehensive synthesis, which provides valuable evidence supporting perioperative dexmedetomidine as a promising adjunct for CPSP prevention[1]. Taken together, these findings highlight the need for regimen-focused, pragmatic, and patient-centered trials that will be essential for defining how dexmedetomidine can be most effectively and safely incorporated into contemporary perioperative practice. Such studies will also help clarify the balance between its potential long-term analgesic benefits and its dose-related hemodynamic risks, thereby guiding more precise and individualized perioperative analgesic strategies. Ethical approval Not applicable. Consent Not applicable.