Dexmedetomidine versus propofol for the prevention of postoperative delirium in older adults undergoing regional anaesthesia: a systematic review and meta-analysis

Rev Esp Anestesiol Reanim (Engl Ed). 2026 Oct 29:502211. doi: 10.1016/j.redare.2026.502211. Online ahead of print.

ABSTRACT

Postoperative delirium (POD) is a common complication in older adults undergoing surgery and is associated with adverse clinical outcomes. The choice of intraoperative sedative may influence its occurrence, particularly in the setting of regional anesthesia. A systematic review and meta-analysis of randomized controlled trials comparing dexmedetomidine versus propofol in patients aged ≥60 years was conducted in accordance with PRISMA guidelines, with protocol registration in PROSPERO. The primary outcome was the incidence of POD assessed using validated instruments (CAM or CAM-ICU). Five randomized controlled trials involving a total of 1,613 patients were included. The incidence of POD was 7.7% in the dexmedetomidine groups and 16.7% in the propofol groups. The meta-analysis showed a significant reduction in POD with dexmedetomidine (RR 0.48, 95% CI 0.36-0.64; p < 0.001), with low heterogeneity (I² = 13.4%). Egger’s test did not show significant evidence of publication bias, and trial sequential analysis suggested that the available evidence is sufficient. The certainty of evidence was rated as moderate according to the GRADE approach. In older adults undergoing surgery under regional anesthesia, intraoperative sedation with dexmedetomidine is associated with a lower incidence of POD compared with propofol.

PMID:42957094 | DOI:10.1016/j.redare.2026.502211