Dexmedetomidine as an adjunctive analgaesic in the perioperative setting: A review of the literature

Reinert, Justin P.; Lang, Andrew; Veronin, Michael A.

doi:10.1177/1750458920971108

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Following surgery, the patient is transferred to the intensive care unit, where intravenous dexmedetomidine (0.1 μg/kg/h) is administered for sedation and analgesia [21]. Patients then self-administer intravenous oxycodone via a patient-controlled analgesia (PCA) device until analgesia is changed (on day 1-7 when PCA requirements become reduced) from intravenous opioid to the preferred agents sublingual buprenorphine or oral tapentadol (immediate-release and modified-release preparations) [22,23].…”

Section: Following Discharge From Hospital: Analgesia Managementmentioning

confidence: 99%

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

et al. 2022

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Aim This study aimed to investigate the implementation and pain‐related outcomes of a peri‐operative pain‐management regimen for patients undergoing pelvic exenteration surgery at a university teaching hospital. Method This is a single‐site prospective observational cohort study involving 100 patients who underwent pelvic exenteration surgery between January 2017 and December 2018. A pain‐management algorithm regarding the use of opioid‐sparing multimodal analgesia was developed between the departments of anaesthesia, pain management and intensive care. The primary outcomes were: compliance with a pain‐treatment algorithm compared with a similar retrospective surgical patient cohort in 2013–2014; and requirements for regular doses of opioid analgesia at discharge, measured in oral morphine equivalent daily dose (oMEDD). Results Following the introduction of a pain‐management algorithm, regional anaesthesia techniques (spinal anaesthesia, transversus abdominus plane block, preperitoneal catheters or epidural analgesia) were used in 83/98 (84.7%) of the 2017–2018 cohort compared with 13/73 (17.8%) of the 2013–2014 cohort (p < 0.001). There was a reduction in the median dose of opioid analgesics (oMEDD) at time of discharge, from 150 mg (interquartile range [IQR]: 75.0–235.0 mg) in the 2013–2014 cohort to 10 mg (IQR: 0.00–45.0 mg) in the 2017–2018 cohort (p < 0.001). There was no change in pain intensity (assessed using the Verbal Numerical Rating Score) or oMEDD in the first 7 days following surgery. Conclusion Since implementation of a novel peri‐operative pain‐treatment algorithm, the use of opioid‐sparing regional techniques and preperitoneal catheters has increased. Additionally, the dose of opioids required at the time of discharge has reduced significantly.

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Section: Following Discharge From Hospital: Analgesia Managementmentioning

confidence: 99%

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

et al. 2022

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“…High concentration of sevoflurane may increase the risk of cardiovascular depression, inhaled anaesthetic toxicity 8 and glycine absorption 9 . Dexmedetomidine is a highly selective alpha 2 ‐adrenergic receptor, known to produce sedation and analgesia without causing significant respiratory depression 10,11 . Many studies have shown that dexmedetomidine can reduce the effective concentration of inhalational anaesthetics 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Minimal alveolar concentration of sevoflurane in combination with dexmedetomidine in patients with hysteroscopy: An up‐down sequential allocation study

Guo

Luo

Jiang

et al. 2022

Basic Clin Pharma Tox

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Background: Dexmedetomidine is commonly used in hysteroscopy surgery due to its analgesia and sedation without respiratory depression. Many studies have shown that dexmedetomidine can reduce the consumption of sevoflurane. However, the optimal end-tidal concentration of sevoflurane when it is co-administered with dexmedetomidine has not been established. The primary purpose of this study was to investigate the minimal alveolar concentration (MAC) of sevoflurane for cervical dilatation combined with different doses of dexmedetomidine in patients with hysteroscopy surgery.Methods: One-hundred patients undergoing hysteroscopy surgery were enrolled in this clinical trial. All the patients were randomly assigned into four groups (C, D 1 , D 2 , D 3 ) and received a loading dose of dexmedetomidine (0, 0.6, 0.8 and 1.0 μg/kg) over 10 min before anaesthesia induction, respectively. Anaesthesia was induced in each patient with 5% sevoflurane in 100% oxygen via a facemask. A laryngeal mask (LMA) was inserted when the patient had lost consciousness and the BIS value decreased below 40. The response to cervical dilatation stimulus (movement vs non-movement) by the insert of hysteroscope was recorded. The MAC of sevoflurane was measured by up and down sequential method of Dixon and Mood and centred isotonic regression analysis. Results: The calculated MAC of sevoflurane using up-and-down method of Dixon and Mood in patients with hysteroscopy surgery was (1.90 AE 0.13)%, (1.23 AE 0.16)%, (1.03 AE 0.10)% and (0.93 AE 0.08)% in groups C, D 1 , D 2 and D 3 , respectively. Conclusions:The administration of dexmedetomidine can significantly decrease the MAC of sevoflurane for hysteroscopy surgery. However, a ceiling effect of the reduction was observed when the dose of dexmedetomidine was higher than 0.8 μg/kg.Yan-Xia Guo and Kai Luo contributed equally to this article and share co-first authorship.

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Dexmedetomidine as an adjunctive analgaesic in the perioperative setting: A review of the literature

Cited by 2 publications

References 23 publications

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

Implementation of a peri‐operative pain‐management algorithm reduces the use of opioid analgesia following pelvic exenteration surgery

Minimal alveolar concentration of sevoflurane in combination with dexmedetomidine in patients with hysteroscopy: An up‐down sequential allocation study

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