Background: Bariatric surgery is associated with significant postoperative challenges, including pain and nausea. Dexmedetomidine (Dex), an alpha-2 adrenergic agonist, is commonly used to manage pain and postoperative nausea and vomiting (PONV) in various surgical settings. This meta-analysis evaluates the efficacy of Dex in bariatric surgery patients, focusing on postoperative pain intensity, opioid consumption, and PONV. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published between 2010 and 2023, assessing Dex use during or after bariatric surgery. Studies comparing Dex to placebo or standard care were included. Data extraction was performed independently by two reviewers, and statistical analysis was conducted using a random-effects model. Study quality was assessed using the Cochrane Risk of Bias tool. Results: Six RCTs (485 participants) met the inclusion criteria. Dex significantly reduced intraoperative fentanyl use (SMD −1.33, 95% CI [−2.19, −0.47], p = 0.002). Pain scores showed mixed results, with some studies reporting lower pain intensity in the Dex group, while others found no significant difference compared to morphine or placebo. PONV scores were generally lower in the Dex group (p = 0.01) compared to placebo and morphine. No significant differences were found in morphine consumption (SMD −1.13, 95% CI [−2.24, 0.01], p = 0.05) or recovery time. Conclusions: Dexmedetomidine appears to reduce opioid requirements and postoperative nausea in bariatric surgery patients. However, the variability in pain management outcomes suggests that further well-designed RCTs are needed to confirm its overall efficacy. The findings are based on moderate-quality evidence, and further research should aim to standardize dosing protocols and patient populations.

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method.