Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Alan David Kaye, David J Chernobylsky, Pankaj Thakur, Harish Siddaiah, Rachel J Kaye, Lauren K Eng, Monica W Harbell, Jared Lajaunie, Elyse M Cornett, Alan David Kaye, David J Chernobylsky, Pankaj Thakur, Harish Siddaiah, Rachel J Kaye, Lauren K Eng, Monica W Harbell, Jared Lajaunie, Elyse M Cornett

Abstract

Purpose of review: Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU).

Recent findings: Dexmedetomidine, a selective alpha2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.

Keywords: Alpha 2 antagonists; Chronic pain; Clonidine; Dexmedetomidine; ERAS.

Conflict of interest statement

David Chernobylsky, Pankaj Thakur, Harish Siddaiah, Rachel Kaye, Lauren Eng, Monica Harbell, Jared Lajaunie, and Elyse Cornett declare no conflict of interest.

Alan Kaye is a Section Editor for Current Headache and Pain Reports. He has not been involved in the editorial handling of this manuscript. Dr. Kaye is also a speaker for Merck.

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