Mechanism, Dose, and Administration of Dexmedetomidine in Managing Visceral Pain Associated With Surgery: A Narrative Review

Ruonan Tian; Zongming Jiang; Han Zhou; Yunzhi Wang

doi:10.12659/MSM.950564

12 February 2026 : Review article

Mechanism, Dose, and Administration of Dexmedetomidine in Managing Visceral Pain Associated With Surgery: A Narrative Review

Ruonan Tian^{EF 1}, Zongming Jiang^{AEFG 1,2*}, Han Zhou^{F 1}, Yunzhi Wang^{F 2}

DOI: 10.12659/MSM.950564

Med Sci Monit 2026; 32:e950564

Authors information Article notes Copyright and License information

Introduction Overview of the Complexities of Visceral Pain Various Administration Modes and Routes of DEX for Relieving Visceral Pain Future Directions Conclusions References

Related articles Order reprints Share article Share by email

View HTML version

Table 1 Preclinical evidence of DEX ameliorates visceral pain.

Year/Refs	Experimental subject	Animal model	DEX administration timing	DEX administration routes	Upward indicators	Reduction indicators	Results	Mechanism
2008/[]⁴²	Wistar rats	Spinal cord Slice	Pretreatment	Superfusion	NR	NR	Hyperpolarizes the membrane potentials of spinal dorsal horn neurons	G-protein-mediated activation of K+ channels through a2AR
2009/[]³⁶	Sprague-Dawley rats	Colorectal distension	Pretreatment	IV	NR	NR	Inhibits the colorectal distension-induced visceral nociceptive response	Opioid receptors
2012/[]⁷²	Wistar rats	Surgical stress and pain	intraoperatively	IV	NR	NR	Attenuates surgical stress and pain-related reduction of microcirculatory blood flow intensity in intestinal mucosa and muscle	NR
2014/[]⁴⁸	BALB/c mice	Endotoxemia	Pretreatment	Intraperitoneally	NR	Proinflammatory cytokine	Suppresses systemic inflammation	Cholinergic anti-inflammatory pathway
2014/[]¹¹¹	Sprague-Dawley rats	Surgical induced inflammation	Pretreatment	Perineural sciatic injection	NR	IL-6 and TNF-α in sciatic nerve	DEX (perineural) exerts anti-inflammatory effects.	Inhibits the translocation of activated NF-κB to the nucleus and its binding activity, thus reducing inflammatory cytokines
2015/[]³⁷	Wistar rats	NR	Pretreatment	Intrathecal administration	MWT	Substance P; CGRP	Antinociceptive effects	activation of α2 AR at the spinal cord level
2015/[]⁷⁴	Sprague-Dawley rats	Intestinal I/R injury	30 min prior to the intestinal I/R	Intraperitoneally	Bcl-2	Intestinal NO levels; TNFα; IL6	Exerts anti-inflammatory and anti-apoptotic properties in the intestine	Downregulated telomerase and caspase3mRNA
2016/[]⁷³	Wistar rats	Endotoxemic model	Continuous infusion	IV	NR	Spleen bacterial colonies	Alleviates endotoxemia-related intestinal microcirculatory dysfunction.	Attenuates intestinal epithelial cell death, tight junction damage
2017/[]⁵³	C57BL/6 mice	Heatstroke	Immediately after heatstroke	Intraperi-Toneally	NR	TNF-a;IL-6;IL-1β	Protects against heatstroke-induced inflammatory response and multi-organ dysfunction	Maintaining intestinal integrity and inhibiting enterocytes apoptosis
2018/[]³¹	Sprague-Dawley rats	Chronic post-ischemia pain	1 h before reperfusion	Intraperi-Toneally	NR	pGluN1 and pERK expression in the spinal cord	Increase MWT	Inhibit the mechanical allodynia and central sensitization
2018/[]⁵⁶	Sprague-Dawley rats	Acute IVP by acetic acid	15 min before model establishment	Subdurally	MWT; TWL	Inflammatory cytokines	Relieves acute IVP	Decreases the activation of ERK, TLR4 signaling, and TRPV1 channel
2019/[]⁴⁷	Sprague-Dawley rats	Chronic IVP	Pretreatment	Subdural injection	MWT; TWL	IL-1β; TNF-α; IL-6	Suppresses visceral hypersensitivity	miR-34a-mediated HDAC2 pathway
2019/[]⁵⁴	Sprague-Dawley rats	Acute liver injury	Pretreatment	Intraperitoneally	The expression of α7nAChR and ACh	Inflammatory cytokines	Significantly prevents LPS-induced acute liver injury	The TLR4/MyD88/NF-κB signaling pathway
2019/[]⁶²	C57BL/6J mice	Traumatic brain injury	Immediately after trauma induction	IV	NR	Inflammatory cytokines	Down-regulate inflammatory cytokines.	Regulates the expression of CD40 and CD86 surface markers on macrophages
2019/[]⁷⁶	Sprague-Dawley rats	orthotopic autologous liver transplant induced acute gut injury	30 min before liver transplant	Intraperitoneally	The expression levels of occludin and ZO-1	ROS	DEX exerts protective effects against acute gut injury	Activating Nrf2/HO-1 signaling to reduce oxidative stress
2020/[]³⁵	Wistar rats	HO-induced dorsal root ganglion neurons	Pretreatment for 24 h	NR	NR	Cell apoptosis; ROS; anaerobic glycolysis	Inhibit HO-induced apoptosis	Inhibit ROS production
2020/[]³⁸	Sprague-Dawley rats	Acute IVP	Pretreatment	Intrathecal injection	MWT; TWL	Proinflammatory cytokines	Suppresses acetic acid-induced visceral pain	Decrease signal transduction of the Keap1/Nrf2/HO-1 axis
2020/[]⁴⁹	Sprague-Dawley rats	Severe acute pancreatitis	30 min before induction of the model	Intraperitoneally	Frequency and amplitude discharge from cervical vagus nerve	TNF-α; IL-6; serum amylase	Alleviates the systematic inflammatory response and pancreatic injury	Cholinergic anti-inflammatory pathway
2020/[]⁶³	C57BL/6 mice	Liver I/R injury	Pretreatment	Intraperitoneally	IL-10	TNF-α; IL-6	Effectively alleviates liver I/R injury.	Promoting macrophage M2 activation in a PPARγ/STAT dependent manner
2021/[]⁵²	CD-1 male mice	Sepsis-associated encephalopathy	5 min after cecal ligation and puncture	Intraperitoneally	NR	IL-1β; TNF-α; IL-6	Attenuates sepsis-associated inflammation and encephalopathy	Via central α2AR
2021/[]⁵⁵	C57BL/6 mice	Peritonitis was induced by zymosan A injection	6 h after the installation of peritonitis	Intraperitoneally	Transforming growth factor-β1	TNF-α; IL-1β	Promotes resolution of inflammation	Increases the CD11b+F4/80+Ly6G+ population in vivo
2022/[]³⁹	Sprague-Dawley rats	Irritable bowel syndrome-like functional chronic visceral pain	Pretreatment	Epidural anesthesia	MWT;TWL	Abdominal withdrawal reflex	Inhibit visceral pain sensitivity	Activation of TLR4 in spinal dorsal horn
2022/[]⁵¹	C57BL/6J mice	Intestinal I/R	Pretreatment	Intraperitoneally	NR	Intestinal injury; norepinephrine; IL-1β; TNF-α	Alleviates cognitive dysfunction	Through the locus coeruleus norepinephrine system
2022/[]⁷⁵	Sprague-Dawley rats	Cardio-pulmonary bypass	Pre-administration	IV	Anti-inflammatory cytokines	Proinflammatory factors	DEX pretreatment attenuates intestinal damage, inhibits inflammatory response	TLR4/JAK2/STAT3-mediated inflammatory pathway
2023/[]³⁴	C57BL/6J mice	Formalin induced pain model	30 min prior to formalin test	Intracranial injection	NR	NR	Ameliorates inflammatory pain	Upregulate Akt/GABAAR subunit complexes
CGRP – calcitonin gene-related peptide; DEX – dexmedetomidine; NR – No report; Refs – References; IV – intravenous injection; IL-6 – interleukin-6; TNF-α – tumor necrosis factor-α; MWT – mechanical withdrawal threshold; TWL – thermal withdrawal latency; NO – nitric oxide; α2AR – alpha 2 adrenoreceptor; I/R –ischemia/reperfusion; IVP – inflammatory visceral pain; ERK – extracellular regulated kinase; TLR4 – Toll-like receptor 4; TRPV1 – transient receptor potential vanilloid 1; LPS – lipopolysaccharide; TLR4/MyD88/NF-κB – Toll-like receptor 4/myeloid differentiation primary response gene 88/nuclear factor-κB; Nrf2/HO-1 – nuclear factor erythroid 2/hemooxygenase-1; ROS – reactive oxygen species; Keap1/Nrf2/HO-1 – Kelch-like ECH-associated protein 1/nuclear factor erythroid 2 related factor 2/hemooxygenase-1; PPARγ/STAT – peroxisome proliferator-activated receptor γ/signal transducer and activator of transcription; TLR4/JAK2/STAT3 – Toll-like receptor 4/Janus kinase2/signal transducer and activator of transcription; Akt/GABAAR – Akt/gamma-aminobutyric subunit A receptor; HDAC2 – histone deacetylase 2.

Back to the Article

Mechanism, Dose, and Administration of Dexmedetomidine in Managing Visceral Pain Associated With Surgery: A Narrative Review

Your Privacy