Dexmedetomidine infusion as an analgesic adjuvant during laparoscopic сholecystectomy: a randomized controlled study

Abstract

BackgroundDexmedetomidine (DEX) has sedative, sympatholytic and analgesic effects and might be beneficial if used as an adjuvant to: improve analgesia; modulate haemodynamic responses to intubation and pneumoperitoneum and; reduce the number of opioid-associated adverse events. The aim of this study was to evaluate the efficacy and safety of DEX infusion during elective laparoscopic cholecystectomy (LC).MethodsA randomized, single-centre, parallel-group, placebo-controlled study was carried out between May 2016 and June 2017. Adult patients (18–79 years) with American Society of Anesthesiology (ASA) physical status I–II were randomly assigned to 0.5 μg/kg/h DEX infusion from induction of anaesthesia to extubation (Group D; n = 30) or normal saline infusion (Group C; n = 30). The primary efficacy outcomes were postoperative morphine consumption. Secondary efficacy outcomes included: time to first use of rescue analgesia; postoperative morphine consumption; intraoperative fentanyl consumption; time from end of surgery to extubation; lengths of intensive care unit (ICU) and general ward stay; degree of postoperative pain 3, 6, 12 and 24 h after surgery; incidence of persistent post-surgical pain.ResultsDEX infusion was associated with a decrease in postoperative morphine consumption (p = 0.001), lower incidence of severe postoperative pain (odds ratio [OR] 9, 95% confidence interval [CI] 1.1–77, p = 0.04) and significantly longer time to first use of rescue analgesia (p = 0.001). Group D also had significantly lower fentanyl consumption both intraoperatively (p = 0.001) and in the time from end of surgery to extubation (p = 0.001) plus decreased incidence of persistent post-surgical pain (OR 14.5, 95% CI 1.7–122, p = 0.005). The incidence of postoperative nausea and vomiting was lower in Group D than Group C (OR 5, 95% CI 1.1–26, p = 0.005). Median pain intensity did not differ between the groups 3, 6, 12 or 24 h after surgery and there were no inter-group differences in the lengths of ICU stay or overall hospital stay between groups. The incidence of hypertension was significantly higher in Group C (OR 13.8, 95% CI 4–48, p < 0.0001); there were no inter-group differences in incidences of hypotension and bradycardia.ConclusionsIntraoperative DEX infusion is safe and effective for improving analgesia during and after elective LC. DEX appears to significantly reduce the number of patients with severe postoperative pain, postoperative morphine consumption and prolong time to first use of rescue analgesia.Trial registrationClinicalTrials.gov: Retrospectively registered on July 7, 2017, NCT03211871.

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis

“…Based on data from 15 RCTs , with a total of 2426 ICU patients, we found no evidence of a decrease in mortality in the dexmedetomidine group compared with placebo OR (95%CI) 0.86 (0.66–1.10), p = 0.23, I 2 = 0%; moderate quality of evidence and inconclusive trial sequential analysis), see Supporting Information (Fig. S1).…”

“…Eight trials with 1090 patients indicated a shorter time to extubation in patients who received dexmedetomidine, MD (95%CI) −1.74 h (−2.64 to −0.84), p < 0.001, I 2 = 100%). The test of heterogeneity was high in the pooled effect; see Supporting Information (Fig.…”

“…Fourteen studies were single‐centre RCTs, whereas 11 studies were multi‐centre RCTs. Most studies examined the prophylactic effect of dexmedetomidine on the reduction of delirium in ICU patients, except two trials which investigated the therapeutic effect of dexmedetomidine.…”

“…Most studies examined the prophylactic effect of dexmedetomidine on the reduction of delirium in ICU patients, except two trials which investigated the therapeutic effect of dexmedetomidine. Twenty studies were conducted in surgical ICU, three were medical ICU and two were based on a combination of medical and surgical ICU patients. The dexmedetomidine regimen varied between studies, with most adopting a goal‐directed approach to titrate the dosage of dexmedetomidine to meet a targeted sedation level.…”

“…Seventeen studies (2501 patients) and 18 studies (2568 patients) reported the incidence of bradycardia and hypotension, respectively. Patients who received dexmedetomidine were more likely to be bradycardic, OR (95%CI) 2.18 (1.46–3.24), p < 0.001, I 2 = 28%, moderate quality of evidence and conclusive trial sequential analysis (Fig.…”