Intraoperative Dexmedetomidine Promotes Postoperative Analgesia and Recovery in Patients after Abdominal Hysterectomy: a Double-Blind, Randomized Clinical Trial

Abstract

Surgery-induced acute postoperative pain and stress response can lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia and recovery following abdominal hysterectomy surgeries. Sixty-four patients scheduled for abdominal hysterectomy under general anesthesia were divided into two groups that were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score immediately after extubation than patients in the PRS group. During the first 24 hours post-surgery, PRD patients consumed less morphine with patient-controlled analgesia (PCA) and had lower scores on a visual analogue scale (VAS) than their controls from the PRS group. The global 40-item quality of recovery questionnaire and 9-question fatigue severity score both showed higher recovery scores from day 3 after surgery in the PRD group. with the data are considered together, intraoperative administration of dexmedetomidine appeared to promote the analgesic properties of morphine-based PCA and to expedite recovery following surgery in patients undergoing abdominal hysterectomy.

Figures

Figure 1. Schematic of anesthesia and post-operative analgesia.

Patients received the same treatments for induction and PCA (see the Methods section). Patients in both groups received anesthesia maintenance with propofol, remifentanil and saline (PRS group) or with dexmedetomidine (PRD group).

Figure 2. Heart rates, MBP, BIS values and Ramsay sedation scores.

(a) Heart rates at different time points. (b) MBP at different time points. (c) BIS values at different time points, ***P < 0.001. (d) Ramsay sedation scale score immediately after extubation, **P = 0.004. For Figure 2a–c: T1: baseline, T2: induction, T3: intubation, T4–T7: 10 min, 30 min, 60 min and 90 min after intubation, respectively, T8: 24 hours after surgery.

Figure 3. 24 hour PCA evaluation and morphine consumption.

(a) VAS pain score at rest at different time points in the two groups, *P = 0.02, 0.04, 0.03 for time points of 2, 4, 12 hours post-operatively, respectively. (b) VAS pain score on movement at different time points in the two groups, *P = 0.03 and 0.02 for time points of 4 and 24 hours post-operatively, respectively, **P = 0.006 for 8 hour post-operative time point. Figure 3c,d show pump press numbers and morphine consumption during the first 24 hours following surgery, *P < 0.05.

Figure 4. Recovery quality evaluation in the two groups.

(a) Global 40-item quality of recovery questionnaire score, *P = 0.04 at POD 3 time point. (b) Nine-question fatigue severity scores, **P = 0.004 at POD 3 time point, and *P = 0.03 at POD 7 time point. BSL: baseline before surgery, POD: post-operative day.

Figure 5. Schematic showing potential relationships among surgery-induced pain, stress and fatigue.