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

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

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Table 2 Clinical evidence of DEX alleviates visceral pain.

Year/Refs	Type of operation/Experimental subject	DEX administration timing	Combination medication	Administration routes	Upward indicators	Reduction indicators	Results
2014/[]⁷⁸	Colorectal surgery	Intraoperative	Adjuvant drug	IV	NR	Resting pain scores	Reduction pain scores at rest
2016/[]¹¹⁵	Laparoscopic surgery	At the end of surgery	DEX with bupivacaine versus bupivacaine alone	Intraperitoneal instillation	Duration of analgesia	VAS	Prolongs the duration of postoperative analgesia
2017/[]⁸³	Abdominal hysterectomy	Intraoperative	Combined with lidocaine	IV	Analgesic and opioid-sparing effects	VAS after surgery; fentanyl doses	Significantly improved postoperative pain and enhanced recovery of bowel function.
2017/[]¹⁰⁵	Cesarean surgery	Preoperative	Low dose of DEX as an adjuvant to bupivacaine	Spinal anesthesia	NR	Plasma IL-6 and cortisol levels	DEX(3 μg) provides better somato-visceral sensory block characteristics and postoperative analgesia
2018/[]⁸¹	Cesarean delivery	After delivery	Combined with sufentanil	IV	Satisfaction degree	VAS; rescue analgesia	Enhance the analgesic effects; improve the recovery of intestinal functions
2018/[]⁸²	Abdominal operation	After abdominal operation	Combined with sufentanil	Patient-controlled analgesia	Satisfaction degree of patient	VAS; sufentanil consumption.	Reduce sufentanil consumption, decrease VAS, lower the rate of nausea and vomiting, improve patient satisfaction
2018/[]⁹¹	Laparoscopic assisted operations on stomach and intestines	Postoperative analgesic	Different doses of DEX in combination with oxycodone	IV	Patients’ satisfaction ratings	VAS at 4, 6, and 12 h after surgery	DEX combined with oxycodone can improve sleep quality and provide good visceral analgesia
2019/[]⁶¹	Videolaparoscopic cholecystectomy	Intraoperative	an adjuvant drug	IV	NR	IL-6; VAS	Good analgesia; faster postoperative recovery
2021/[]²⁸	Thoracotomy	Intraoperative	An adjuvant drug	IV	NR	TLR4 and NF-κB expressions; TNF-α; IL-1β; epinephrine and norepinephrine	Reduce the stress response and postoperative pain intensity
2021/[]⁹⁹	Laparoscopic cholecystectomy	Before induction	Different doses of DEX	IV	NR	VAS; the dosage of postoperative analgesic	IV infusion of 0.6 μg/kg DEX can maintain hemodynamic stability, relieve postoperative pain
2021/[]¹⁰¹	Laparoscopic hysterectomy	10 min before the induction of anesthesia-30 min before the end of the operation	Combined with lidocaine	IV	NR	IL-1β; IL-6; TNF-α; intraoperative consumption of remifentanil and propofol; post-operative VAS at rest	The combination of lidocaine and DEX significantly alleviated the inflammatory responses, decreased postoperative pain
2021/[]¹⁰⁴	Thoracoscopic surgery	Postoperative	Combined with sufentanil and dezocine	Patient-controlled analgesia	Patients’ overall satisfaction degree	Postoperative pain scores; the incidence of nausea and vomiting	Enhanced patient satisfaction, improved postoperative analgesia, and reduced postoperative nausea and vomiting
2021/[]¹²⁰	Laparoscopic cholecystectomy	Postoperative	DEX versus clonidine as adjuvants to local anesthetic	Intraperitoneal instillation	Duration of analgesia	NR	The addition of DEX to bupivacaine for intraperitoneal injection provides a longer period of postoperative analgesia
2022/[]⁷⁷	Gastro-intestinal surgery	Intraoperative	An adjuvant drug	IV	a7nAChR level	TNF-α; hospital stay; D-lactate level	DEX maintained intestinal barrier integrity
2022/[]⁷⁹	Colorectal surgery	Intraoperative	Bolus plus maintenance dose	IV	IL-10	IL-6; TNF-α; cyclo-oxygenase-2; inducible nitric oxide synthase; lipopolysaccharide	DEX used with an extra loading dose enhanced the recovery of gastrointestinal function
2022/[]⁸⁰	Laparoscopic hysteromyomectomy	Intraoperative	An adjuvant drug	IV	NR	First flatus, first oral feeding, and first defecation; postoperative pain scores.	Improve gastrointestinal function recovery after laparoscopic hysteromyomectomy
2022/[]¹¹⁸	Abdominal laparoscopic cancer Surgeries	Before start of surgery or after completion of surgery	DEX versus tramadol as adjuvants to local anesthetic (bupivacaine)	Intraperitoneal instillation	NR	Opioid consumption	DEX as an adjuvant drug to bupivacaine resulted in significant reduction in perioperative fentanyl consumption
2023/[]⁴¹	Cesarean section	preoperative	Combined with ropivacaine	Epidural anesthesia	Sedation scores	Visceral traction reaction	Alleviate visceral traction reaction
2023/[]⁶⁰	Video-laparoscopic cholecystectomy	Intraoperative	An adjuvant drug	IV	NR	IL-6	Lower pain and opioid consumption in the first postoperative hour
2023/[]⁹⁴	Major non-cardiac surgery	Initiated from the end of surgery	Supplementing IV analgesia with mini-dose DEX	IV	Percentage of N2 sleep	Percentage of N1 sleep	Improve sleep structure without increasing sedation in older patients recovering from major surgery
2023/[]⁹⁷	Emergency trauma surgery	Intraoperative	An adjuvant drug	IV	Sleep quality	Beck anxiety inventory for anxiety score	Lower post-traumatic stress disorder incidence; improved sleep quality
2023/[]⁹⁸	Epidural labor analgesia	Immediately after labor analgesia	Different doses of DEX	IV	NR	VAS	Low-dose DEX is highly safe and effectively relieves the pain of puerperae and shorten the labor process
2023/[]¹⁰²	Cesarean delivery	Postoperative	Administration of DEX with nalbuphine versus sufentanil	Patient-controlled analgesia	Patient’s satisfaction	Adverse reactions	The combination yields superior efficacy in alleviating postoperative visceral pain and fewer side effects
2023/[]¹⁰⁹	Thoracic surgery	Preoperative	DEX versus dexamethasone as adjuvants to local anesthetic (ropivacaine)	Epidural anesthesia	NR	VAS	DEX was more efficient in lowering pain and analgesia requirements 24 h after the surgery
2023/[]¹¹⁹	Laparoscopic surgeries	Postoperative	DEX versus ketamine as adjuvants to local anesthetic (ropivacaine)	Intraperitoneal instillation	NR	VAS	Intraperitoneal instillation of local anesthetics with DEX is more effective for postoperative analgesia
2024/[]⁴⁰	Cesarean section	After umbilical cord clamping	Combined with esketamine	Spinal-epidural anesthesia	NR	VAS	Alleviate visceral traction pain
2024/[]¹⁰⁰	Laparoscopic cholecystectomy	Premedication	Low-dose DEX as an adjuvant drug	IV	Incidence of bradycardia	Anesthetic consumption; postoperative VAS	Effectively attenuate intraoperative stress response and postoperative pain
2024/[]¹¹⁶	Malignancy-associated refractory abdominal pain	Premedication	An adjuvant drug	Splanchnic nerve neurolysis	NR	VAS, morphine requirement	Improves pain results from refractory cancer related pain
2024/[]¹²¹	Laparoscopic hysterectomy	Before the end of pneumoperitoneum	DEX with ropivacaine versus ropivacaine alone	Intraperitoneal spraying	40-item questionnaire	VAS; incidences of dizziness, nausea, and vomiting	Improves the quality of recovery, postoperative analgesia after general anesthesia
2024/[]¹²⁴	Cesarean sections	Preoperative	DEX with ropivacaine versus ropivacaine alone	Transversus abdominis plane block	Duration of analgesia; patient’s satisfaction	VAS at 12 h and 18 h after surgery	Significantly increases the duration of postoperative analgesia
DEX – dexmedetomidine; NR – no report; Refs – references; VAS – visual analogue scale; IV – intravenous injection; IL-6 – interleukin 6; IL-10 – interleukin 10; IL-1β – interleukin-1β; TLR – toll-like receptor; NF-κB – nuclear factor-κB.

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

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