Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy: A CONSORT-Prospective, Randomized, Controlled Trial

Abstract

Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms, and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy.This CONSORT-prospective, randomized, double-blinded, controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia (PCA) for 72 hours after abdominal hysterectomy.Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil (Group C; 0.02 μg/kg/h), sufentanil plus dexmedetomidine (Group D1; 0.02 μg/kg/h, each), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.05 μg/kg/h) (Group D2) for 72 hours after surgery in this double-blinded, randomized study. The primary outcome measure was the postoperative sufentanil consumption, whereas the secondary outcome measures were pain intensity (visual analogue scale), requirement of narcotic drugs during the operation, level of sedation, Bruggrmann comfort scale, and concerning adverse effects.The postoperative sufentanil consumption was significantly lower in Groups D1 and D2 than in Group C during the observation period (P < 0.05), but lower in Group D2 than in Group D1 at 24, 48, and 72 hours after surgery (P < 0.05). The heart rate after intubation and incision was lower in Groups D1 and D2 than in Group C (P < 0.05). On arrival at the recovery room, Groups D1 and D2 had lower mean blood pressure than Group C (P < 0.05). The intraoperative requirement of sevoflurane was 30% lesser in Groups D1 and D2 than in Group C. The sedation levels were greater in Groups D1 and D2 during the first hour (P < 0.05). Compared with Groups C and D1, Group D2 showed lower levels of the overall incidence of nausea and vomiting (P < 0.05).Among the tested PCA options, the addition of dexmedetomidine (0.05 μg/kg/h) and sufentanil (0.02 μg/kg/h) showed better analgesic effect and greater patient satisfaction without other clinically relevant side effects for patients undergoing hysterectomy during the first 72 hours after abdominal hysterectomy.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1

Patient enrollment flow diagram. This illustrates the flow of all patients screened, excluded, and randomized.

FIGURE 2

(A) Comparison of heart rates (HR) (beats/min) among the 3 groups at different time points: HR in Groups D1 and D2 was lower than that in Group C at T(post-int) and T(pre-inc) (P < 0.05). (B) Comparison of mean blood pressure (MBP) (mm Hg) in the 3 groups at different time points: MBP in Group D2was also lower than that in Groups C and D1 at T0, T0+10’, T0+20’, T0+30’, T0+40’ (P < 0.05). The whisker caps correspond to the fifth and 95th confidence interval. ∗P < 0.05 versus Group C. #P < 0.05 versus Group D1.

FIGURE 3

Postoperative consumption of PCA sufentanil in the 3 groups. ∗P < 0.05 versus Group C. #P < 0.05 versus Group D1.

FIGURE 4

Time course of postoperative pain (at rest/movement) expressed as scores on a visual analogue scale (VAS) out of 10 in the 3 groups: (A) the VASr (postoperative pain [at rest]) and (B) the VASm (postoperative pain [at movement]). ∗P < 0.05 versus Group C; #P < 0.05 versus Group D1.

FIGURE 5

(A) Comparison of patients’ sedation among the 3 groups. LOS = level of sedation (0, fully awake; 1, drowsy/closed eyes; 2, asleep/easily aroused with light tactile stimulation or a simple verbal command; 3, asleep/arousable only by strong physical stimulation; 4, unarousable). (B) Comparison of patients’ satisfaction (BCS) among the 3 groups. BCS = Bruggemann comfort scale (0, persistent pain; 1, severe pain while deep breathing or coughing; 2, mild pain while deep breathing or coughing; 3, no pain while deep breathing; 4, no pain while coughing). ∗P < 0.05 versus Group C; #P < 0.05 versus Group D1.