Comparative study between the effect of dexmedetomidine and lidocaine infusion in lumbar fixation on hemodynamics, fentanyl requirements, and postoperative analgesia

Abstract

Background Spinal surgery is associated with high incidence of severe postoperative pain difficult to easy control. Appropriate treatment modalities decreased the postoperative morbidity, increased patient satisfaction, allowed early mobility, and decreased hospital costs. Lidocaine was used as intravenous additives to control intraoperative pain and decrease postoperative pain. As lidocaine, dexmedetomidine infusion associated with lower postoperative pain scores decreased the opioid consumption and its related adverse events. The aim of this double blind randomized prospective comparative study was to compare the efficacy of intraoperative dexmedetomidine versus lidocaine infusion on hemodynamics, fentanyl requirements, and postoperative analgesia among 66 patients subjected to lumbar fixation surgery and randomized into group D which received dexmedetomidine 1 μg/kg infusion over 10 min as a loading dose then 0.3–0.5 μg/kg/h after induction of anesthesia as maintenance dose and group X which received lidocaine 0.3–0.5 mg/kg/h after induction of anesthesia. Results At 10, 15, 30, and 60 min, the mean arterial blood pressure and heart rate significantly decreased in group D compared to group X, and there was significantly higher total dose of intraoperative analgesic for fentanyl in group X than group D. There was significantly higher numeric rating scale in group X compared to group D at 2, 4, 6, 9, 12, 18, and 24 h postoperative with significant early request of the first analgesia, higher incidence of analgesic needs, and higher dose of postoperative analgesia paracetamol, voltaren, or pethidine in group X compared to group D. Conclusions The intraoperative use of dexmedetomidine IV infusion was an alternative mode to decrease the demands of analgesia following spine surgery.

Comparative study between the effect of dexmedetomidine and lidocaine infusion on intraoperative analgesic requirement and hemodynamics during craniotomy

“…The present study finds that patients receiving intraoperative dexmedetomidine infusion consumed about 55 mcg less fentanyl consumption in the intraoperative period in comparison with lidocaine infusion. The observation of the present study is in line with that observed by Mohammed et al, 11 who found considerably lower consumption (286 vs. 876 mcg) of a total dose of intraoperative analgesics (fentanyl) in patients receiving dexmedetomidine compared with lidocaine. Another study by Menshawi and Fahim 10 also reports lower consumption of intraoperative analgesics with the use of intraoperative infusion of dexmedetomidine over lidocaine (about 93 mcg vs. 105 mcg, respectively).…”

“…The amount of intraoperative fentanyl consumption varied widely in different studies. For example, the reported amount of intraoperative fentanyl requirement was found to be 20.5 mcg 16 , 104.7 mcg 10 , 229.5 mcg, 17 and 876 mcg 11 in groups using lidocaine while it was 26.5 mcg, 92.9 mcg, 229.7 mcg, and 286 mcg, respectively, in groups using dexmedetomidine in those studies. Several factors contributed to heterogeneity among different studies.…”

“…Most of the studies have focused on assessing intraoperative hemodynamics such as heart rate (HR) or mean arterial pressure (MAP) and post-operative pain scores or total analgesics consumption in the post-operative period. Some studies 10,11 have already focused on the effects of these drugs on intraoperative analgesic consumption. Mohammed et al 11 observed a considerably higher analgesic (fentanyl) consumption in the intraoperative period with the use of lidocaine infusion compared with dexmedetomidine while Menshawi and Fahim 10 have found no significant difference.…”

“…Some studies 10,11 have already focused on the effects of these drugs on intraoperative analgesic consumption. Mohammed et al 11 observed a considerably higher analgesic (fentanyl) consumption in the intraoperative period with the use of lidocaine infusion compared with dexmedetomidine while Menshawi and Fahim 10 have found no significant difference. Again, the use of dexmedetomidine has led to a considerable reduction of HR and MAP in the intraoperative period in one study 12 while another study 10 reports no significant difference when compared with lidocaine.…”

Comparison of Intraoperative Low-Dose Ketodex and Fentanyl Infusion for Postoperative Analgesia In Spine Surgery: A Prospective Randomized Double-Blind Study

“…A prospective randomized controlled trial compared the effects of intraoperative dexmedetomidine and lidocaine infusion on hemodynamics, fentanyl requirements, and postoperative analgesia among patients undergoing lumbar fixation surgery. Akin to our study, the MAP and HR were lower in the dexmedetomidine group than in the lidocaine group [18]. In our study, none of the patients experienced dexmedetomidine-induced bradycardia or severe hypotension; this may be imputable to the concurrent administration of ketamine, which counterbalances the parasympathetic override of dexmedetomidine.…”