Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Abstract

BACKGROUND: Dexmedetomidine was reported to reduce postoperative acute pain after neurosurgery. However, the efficacy of dexmedetomidine for preventing chronic incisional pain is uncertain. METHODS: This article is a secondary analysis of a randomized, double-blind, placebo-controlled trial. Eligible patients were randomly allocated to either the dexmedetomidine group or the placebo group. Patients assigned to the dexmedetomidine group were given a 0.6 μg kg −1 dexmedetomidine bolus followed by a 0.4 μg kg −1 h −1 maintenance dose until dural closure; placebo patients were given comparable amounts of normal saline. The primary end point was the incidence of incisional pain at 3 months after craniotomy evaluated by numerical rating scale scores and defined as any score >0. The secondary end points were postoperative acute pain scores, sleep quality, and Short-Form McGill Pain Questionnaire (SF-MPQ-2) at 3 months after craniotomy. RESULTS: From January 2021 to December 2021, a total of 252 patients were included in the final analysis: the dexmedetomidine group (n = 128) and the placebo group (n = 124). The incidence of chronic incisional pain was 23.4% (30 of 128) in the dexmedetomidine group versus 42.7% (53 of 124) in the placebo group (risk ratio, 0.55; 95% confidence interval, 0.38-0.80; P = .001). The overall severity of chronic incisional pain was mild in both groups. Patients in the dexmedetomidine group had lower acute pain severity on movement than those in the placebo group for the first 3 days after surgery (all adjusted P < .01). Sleep quality did not differ between groups. However, the SF-MPQ-2 total sensory (P = .01) and neuropathic pain descriptor (P = .023) scores in the dexmedetomidine group were lower than those in the placebo group. CONCLUSIONS: Prophylactic intraoperative dexmedetomidine infusion reduces the incidence of chronic incisional pain as well as acute pain score after elective brain tumor resections. (Anesth Analg 2024;138:839-47) KEY POINTS• Question: Did intraoperative administration of dexmedetomidine prevent chronic incisional pain after craniotomy? • Findings: Compared with placebo, prophylactic intraoperative dexmedetomidine infusion reduced the incidence of chronic incisional pain after elective brain tumor resections. • Meaning: Our data suggest that prophylactic intraoperative dexmedetomidine may reduce chronic incisional pain after craniotomy. GLOSSARYASA = American Society of Anesthesiologists; ASD = absolute standard difference; BIS = bispectral index; CAD = coronary artery disease; CI = confidence interval; CONSORT = Consolidated Standards of Reporting Trials; Etco 2 = end-tidal carbon dioxide; IQR = interquartile range; NA = not applicable; NRS = numerical rating scale; PACU = postanesthesia care unit; RR = risk ratio; SD = standard deviation; SF-MPQ-2 = Short-Form McGill Pain Questionnaire-2; TED = tumor equivalent diameter