Intraoperative Dexmedetomidine Promotes Postoperative Analgesia and Recovery in Patients after Abdominal Colectomy: A CONSORT-Prospective, Randomized, Controlled Clinical Trial

Dong-Jian Ge, Bin Qi, Gang Tang, Jin-Yu Li, Dong-Jian Ge, Bin Qi, Gang Tang, Jin-Yu Li

Abstract

Surgery-induced acute postoperative pain and stress response may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia and recovery after abdominal colectomy surgeries.Sixty-seven patients scheduled for abdominal colectomy under general anesthesia were divided into two groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS).During surgery, patients in the PRD group had a lower bispectral index value, which indicated a deeper anesthetic state and a higher sedation score right after extubation, than patients in the PRS group. During the first 24 hours after surgery, PRD patients consumed less morphine in patient-controlled analgesia, and had a lower score in visual analog scale, than their controls from the PRS group. The global 40-item quality of recovery questionnaire and 9-question fatigue severity score both showed a higher recovery score from day 3 after surgery in the PRD group.Intraoperative administration of dexmedetomidine seems to promote the analgesic property of morphine-based patient-controlled analgesia, and speed recovery from surgery in patients after abdominal colectomy.

Conflict of interest statement

The authors have no conflicts of interests or financial ties to disclose.

Figures

FIGURE 1
FIGURE 1
Consort flow diagram.
FIGURE 2
FIGURE 2
Schematic of anesthesia and postoperation analgesia. Patients received same treatments for induction and PCA (see “Methods” section). Patients in both the groups received anesthesia maintenance with propofol, remifentanil, and saline (PRS group), or dexmedetomidine (PRD group). PCA = patient-controlled analgesia, PRD = propofol/remifentanil/dexmedetomidine, PRS = propofol/remifentanil/saline.
FIGURE 3
FIGURE 3
Heart rates, MBP, BIS value, and Ramsay sedation score. A, Heart rates at different time points. B, MBP at different time points. C, BIS values at different time points (∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.0001). D, Ramsay sedation scale score right after extubation (∗P < 0.01). For A–C: T1: baseline, T2: induction, T3: intubation, T4–T7: 10, 30, 60, and 90 minutes after intubation, T8: 24 hours after surgery. BIS = bispectral index, MBP = mean blood pressure.
FIGURE 4
FIGURE 4
The 24-hour PCA evaluation and morphine consumption. A, VAS pain score at rest at different time points in the 2 groups (∗P < 0.05). B, VAS pain score on movement at different time points in the 2 groups (∗P < 0.05). C and D, The pump-press numbers and morphine consumption during the first 24 hours after surgery are shown (∗P < 0.05).
FIGURE 5
FIGURE 5
Recovery quality evaluation in the 2 groups. A, Global 40-item quality of recovery questionnaire score (∗P < 0.05). B, Nine-question fatigue severity scores (∗P < 0.05). BSL = baseline before surgery, POD = postoperation day.
FIGURE 6
FIGURE 6
Schematic showing potential relationships among surgery-induced pain, stress, and fatigue.

References

    1. Bekker A, Haile M, Kline R, et al. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery. J Neurosurg Anesthesiol 2013; 25:16–24.
    1. Zhu Q, Sun Y, Yun X, et al. Antinociceptive effectsof curcumin in a rat model of postoperative pain. Sci Rep 2014; doi: 10.1038/srep04932.
    1. An LX, Chen X, Ren XJ, et al. Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing a supratentorial craniotomy. Am J Chin Med 2014; 42:1099–1109.
    1. Walder B, Schafer M, Henzi I, et al. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand 2001; 45:795–804.
    1. Grosu I, Lavand’homme P. Use of dexmedetomidine for pain control. F1000 Med Rep 1000; 2:M2–90.
    1. Kim SY, Kim JM, Lee JH, et al. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth 2013; 111:222–228.
    1. Gupta N, Rath GP, Prabhakar H, et al. Effect of intraoperative dexmedetomidine on postoperative recovery profile of children undergoing surgery for spinal dysraphism. J Neurosurg Anesthesiol 2013; 25:271–278.
    1. Kim SH, Oh YJ, Park BW, et al. Effects of single-dose dexmedetomidine on the quality of recovery after modified radical mastectomy: a randomised controlled trial. Minerva Anestesiol 2013; 79:1248–1258.
    1. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013; 35:121–126.
    1. Hwang W, Lee J, Park J, et al. Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: a randomized controlled study. BMC Anesthesiol 2015; 15:015–24.
    1. Gornall BF, Myles PS, Smith CL, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth 2013; 111:161–169.
    1. Myles PS, Weitkamp B, Jones K, et al. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth 2000; 84:11–15.
    1. Movafegh A, Shoeibi G, Ansari M, et al. Naloxone infusion and post-hysterectomy morphine consumption: a double-blind, placebo-controlled study. Acta Anaesthesiol Scand 2012; 56:1241–1249.
    1. George RB, McKeen DM, Andreou P, et al. A randomized placebo-controlled trial of two doses of pregabalin for postoperative analgesia in patients undergoing abdominal hysterectomy. Can J Anaesth 2014; 61:551–557.
    1. Liu H, Hu X, Duan X, et al. Thoracic epidural analgesia (TEA) vs. patient controlled analgesia (PCA) in laparoscopic colectomy: a meta-analysis. Hepatogastroenterology 2014; 61:1213–1219.
    1. Engelman E, Marsala C. Efficacy of adding clonidine to intrathecal morphine in acute postoperative pain: meta-analysis. Br J Anaesth 2013; 110:21–27.
    1. Lambert P, Cyna AM, Knight N, et al. Clonidine premedicationfor postoperative analgesia in children. Cochrane Database Syst Rev 2014; doi:10.1002/14651858.
    1. Gil DW, Cheevers CV, Kedzie KM, et al. Alpha-1-adrenergic receptor agonist activity of clinical alpha-adrenergic receptor agonists interferes with alpha-2-mediated analgesia. Anesthesiology 2009; 110:401–407.
    1. Rajan S, Hutcherson MT, Sessler DI, et al. The effects of dexmedetomidine andremifentanil on hemodynamic stability and analgesic requirement after craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol 2015; 28: DOI: 10.1097/ANA.0000000000000221.
    1. Jones JS, Cotugno RE, Singhal NR, et al. Evaluation of dexmedetomidine and postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital. Pediatr Crit Care Med 2014; 15: 0000000000000119.
    1. McQueen-Shadfar LA, Megalla SA, White WD, et al. Impact of intraoperative dexmedetomidine on postoperative analgesia following gynecologic surgery. Curr Med Res Opin 2011; 27:2091–2097.
    1. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59:263–268.
    1. Buyukkocak U, Ozcan S, Daphan C, et al. A comparison of four intravenous sedation techniques and Bispectral Index monitoring in sinonasal surgery. Anaesth Intensive Care 2003; 31:164–171.
    1. Ozturk L, Kesimci E, Albayrak T, et al. Bispectral index-guided general anaesthesia in combination with interscalene block reduces desflurane consumption in arthroscopic shoulder surgery: a clinical comparison of bupivacaine versus levobupivacaine. BMC Anesthesiol 2015; 15:015–0087.
    1. Chattopadhyay U, Mallik S, Ghosh S, et al. Comparison between propofol and dexmedetomidine on depth of anesthesia: a prospective randomized trial. J Anaesthesiol Clin Pharmacol 2014; 30:550–554.
    1. Zhang H, Zhou F, Li C, et al. Molecular mechanisms underlying the analgesic property of intrathecal dexmedetomidine and its neurotoxicity evaluation: an in vivo and in vitro experimental study. PLoS One 2013; 8: doi: 10.1371/journal.pone.0055556.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner