CONSORT the effect of a bolus dose of dexmedetomidine on postoperative pain, agitation, and quality of recovery after laparoscopic cholecystectomy

Abstract

Background: The perioperative administration of dexmedetomidine may improve the quality of recovery (QoR) after major abdominal and spinal surgeries. We evaluated the effect of an intraoperative bolus of dexmedetomidine on postoperative pain, emergence agitation, and the QoR after laparoscopic cholecystectomy.

Methods: Patients undergoing elective laparoscopic cholecystectomy were randomized to receive dexmedetomidine 0.5 μg/kg 5 minutes after anesthesia induction (dexmedetomidine group, n = 45) or normal saline (control group, n = 45). The primary outcome was the QoR at the first postoperative day using a 40-item scoring system (QoR-40). Secondary outcomes included intraoperative hemodynamic parameters, postoperative agitation, pain, and nausea and vomiting.

Results: The heart rate and the mean blood pressure were significantly lower in the dexmedetomidine group than in the control group (P < .001 and .007, respectively). During extubation, emergence agitation was significantly lower in the dexmedetomidine group than in the control group (23% vs 64%, P < .001). The median pain scores in the post-anesthetic care unit were significantly lower in the dexmedetomidine group than in the control group (4 [2-7] vs 5 [4-7], P = .034). The incidence of postoperative agitation, pain, and nausea and vomiting was not different between the groups. On the first postoperative day, recovery profile was similar between the groups. However, the scores on the emotional state and physical comfort dimensions were significantly higher in the dexmedetomidine group than in the control group (P = .038 and .040, respectively).

Conclusions: A bolus dose of dexmedetomidine after anesthesia induction may improve intraoperative hemodynamics, emergence agitation, and immediate postoperative analgesia. However, it does not affect overall QoR-40 score after laparoscopic cholecystectomy.

Trial registration: ClinicalTrials.gov NCT03468062.

Conflict of interest statement

The authors report no conflicts of interest.

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1

Patient's allocation flow diagram. QoR-40 = multidimensional 40-item Quality of Recovery Questionnaire.

Figure 2

Intraoperative hemodynamic and bispectral index changes. Error bar means standard deviation. The changes in mean blood pressure (MBP, upper frame) and heart rate (HR, middle frame) were significantly different between the control (●, filled circle) and dexmedetomidine (□, empty square) groups. MBP and HR were significantly lower in the dex group than in the control group. Changes in bispectral index were not significantly different between the 2 groups. There are 6 time points of measurement: Baseline, before anesthesia induction; IND10, 10 min after anesthesia induction (at the end of study drug infusion); PP10 and PP30, at 10 min and 30 min after pneumoperitoneum; Op End, at the completion of surgery; extubation, immediately after extubation. ∗P < .05, versus baseline value within the group.