Effect of the perioperative infusion of dexmedetomidine on chronic pain after breast surgery

Abstract

Background:This prospective double-blind trial was undertaken to analyze the role of perioperatively administered dexmedetomidine on the occurrence of chronic pain in cases undergoing surgery for breast cancer.Subjects and Methods:Eighty-six cases were randomly assigned to two groups to receive either dexmedetomidine (2 μg/ml) in group D or saline in group C, in a loading dose of 0.5 ml/kg, intravenous (IV), 30 min prior to induction, followed by a continuous infusion of 0.25 ml/kg/h IV till the completion of surgery, and then the dose tapered to 0.1 ml/kg/h for up to 24 h. The standardized questionnaires that measured chronic pain (Brief Pain Inventory, BPI; Short Form McGill Pain Questionnaire, SF-MPQ2) and quality of life (Quality of Life Scale, QOLS) were gathered after 3 months of surgery as a primary outcome. Pain (verbal numerical score, VNS), sedation scores (Ramsay scoring), and analgesic requirements were also assessed for 72 h postoperatively.Results:In total, 84 cases (n=42) were analyzed for acute pain and 69 (34 in group D and 35 in group C) for chronic pain. The consumption of isoflurane/fentanyl intra-operatively and paracetamol postoperatively was significantly lower in Group D. The sedation scores were non-significant between the groups. The VNS at rest and after movement was significantly lower in group D at corresponding times (except at 60 min) throughout the assessment period. The BPI and SF-MPQ2 scores were significantly lower in group D in most of the factors. The QOLS score was significantly better in group D in all items except for relationships, friends, and learning.Conclusion:The perioperative infusion of dexmedetomidine has a pivotal role in attenuating the incidence and severity of chronic pain and improving the quality of life in cases undergoing breast cancer surgery.

Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

“…However, the morphine group required 66% more morphine to achieve the same analgesic effect as the dexmedetomidine group. The reduction of postoperative pain by dexmedetomidine could be explained by the activation of the α 2 -adrenoreceptor in the dorsal horn of the spinal cord, which inhibits the release of substance P, which modulates the transmission of nociceptive signals in the central nervous system, leading to reduction of nociceptive inputs during the acute postoperative period [ 20 ].…”

Prevalence of Phantom Breast Pain and Sensation Among Postmastectomy Patients Suffering from Breast Cancer: A Prospective Study

“…Preoperative use of EMLA cream, venlafaxine, and pre‐emptive analgesia with NSAIDs have also found to decrease the incidence of chronic pain after breast surgery . Perioperative infusion of dexmedetomidine has been reported to decrease the incidence and severity of chronic pain and improve quality of life . In a recent study, it was found that the anesthetic technique involving propofol resulted in a lesser incidence of chronic pain as compared to sevoflurane …”

“…23,52,53 Perioperative infusion of dexmedetomidine has been reported to decrease the incidence and severity of chronic pain and improve quality of life. 54 In a recent study, it was found that the anesthetic technique involving propofol resulted in a lesser incidence of chronic pain as compared to sevoflurane. 55 The result of our study was limited by various factors including:…”

Preventive Effectiveness of Pregabalin in Chronic Neuropathic Pain Syndrome After Mastectomy Due to Cancer

“…Al comparar nuestros resultados con otro tipo de intervenciones para SDCN postmastectomía, que fueron reportados como "disminución estadísticamente significativa" como los de Mingyang con flurbiprofeno (3), Jain con dexmedetomidina (10) preoperatoria, Terkawi (9) con infusión intraoperatoria de lidocaína intravenosa y los reportes del metanálisis de Arm et al (8), que concluye que la venlafaxina disminuye la incidencia de SDCN. Todo lo anterior, a pesar de no ser comparables dados los diferentes tipos de diseño, intervenciones, seguimiento y evaluación del SDCN, nos sugiere una realización de un estudio comparando pregabalina con este medicamento, homogenizando la muestra, momento y duración de la intervención, con seguimiento mínimo de 6 meses y óptimo de un año.…”

“…(4) El diagnóstico de ésta entidad es clínico y está dado por la presencia de síntomas sensoriales, motores o autonómicos como dolor quemante, punzante, parestesias y signos que deben ser evaluados por quien desea realizar el diagnóstico como hipoestesia al tacto, al frío, hipoalgesia, hiperalgesia a estímulos puntiformes, al frío, al calor, alodinia utilizando a su vez diversos instrumentos como la escala de LANSS (Leeds assessment of neuropathic symtoms and signs) (5) y el DN4 (dolour Neuropathique 4') validados al español desde el año 2006 y 2007 respectivamente. (6,7) Para prevenir la aparición del SDCN postmastectomía se han postulado distintas posibilidades farmacológicas como por ejemplo flurbiprofeno (3), venlafaxina, gabapentin (8), infusión de lidocaína intraoperatoria (9), dexmedetomidina perioperatoria en infusión (10) pero no se ha llegado a un consenso a nivel mundial sobre cuál de éstas intervenciones es la ideal para lograr éste propósito.…”