Background It remains unclear whether the opioidsparing effects of dexmedetomidine seen in patients undergoing general anesthesia are reproducible in patients undergoing spinal anesthesia. We hypothesized that the administration of intravenous dexmedetomidine for sedation during total knee arthroplasty under spinal anesthesia would decrease postoperative morphine consumption in the first 24 hr following surgery. Methods We conducted this prospective double-blind randomized-controlled trial in 40 patients (American Society of Anesthesiologists physical status I-III) undergoing total knee arthroplasty with a standardized spinal anesthetic. Patients were randomized to receive either a dexmedetomidine loading dose of 0.5 lgÁkg -1 over ten minutes, followed by an infusion of 0.5 lgÁkgÁhr -1 for the duration of the surgery, or a normal saline loading dose and an infusion of an equivalent volume. The primary outcome was the consumption of morphine delivered via patientcontrolled analgesia in the first 24 hr following surgery. Results The mean (SD) cumulative morphine at 24 hr in the dexmedetomidine group was 29.2 (11.2) mg compared with 61.2 (17.2) mg in the placebo group (mean difference, 32.0 mg; 95% confidence interval, 22.7 to 41.2; P \ 0.001). In the dexmedetomidine group, there was a delay in the time to first analgesic request (P = 0.003) and a reduction in the mean morphine use at six and 12 hr following surgery (both P \ 0.001).Conclusions Dexmedetomidine was associated with a significant decrease in morphine use in the first 24 hr following total knee arthroplasty. Our study shows that an intraoperative infusion of dexmedetomidine for sedation in patients receiving spinal anesthesia can produce postoperative analgesic effects. This offers another potential adjunct in the multimodal pain management of these patients. This trial was registered at ClinicalTrials.gov (identifier NCT02026141).
To the Editor, The laryngeal mask supraglottic airway (SGA) is commonly used in anesthesiology and is often lubricated for easy insertion. We studied sore throat (primary outcome), cough, and laryngospasm after insertion of the LMAÒ Classic TM (Teleflex Inc.; Morrisville, NC, USA) comparing three lubricating strategies: water-soluble medical lubricant (M) (Muko TM ; Source Medical, Mississauga ON, Canada) or 2% lidocaine jelly (L) (Lidodan TM ; Odan Laboratories, Montreal QC, Canada) vs no lubricant control (C). After institutional ethical approval, A consenting American Society of Anesthesiologists physical status I-II adult patients having elective surgery where an LMA was planned were recruited. Those with asthma, sore throat, cough, or allergy to lidocaine or Muko were excluded. Participants were randomly assigned after anesthesia induction by opening an opaque envelope, prepared by the research pharmacist, that contained a 3-mL syringe with Muko, lidocaine jelly, or nothing, with instructions to apply the lubricant to the entire inflatable surface of the LMA. Patients, investigators, and other caregivers were blinded to group assignment. The anesthesiologist was blinded to the lubricants, but not to lubricant vs. controls. This letter is accompanied by an editorial. Please see Can J Anesth 2018; 65: this issue.
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