Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: randomized trial

Hetta, Diab Fuad; Fares, Khaled Mohamed; Abedalmohsen, Abualauon Mohamed; Abdel‐Wahab, Amani H.; Elfadl, Ghada Mohammed Abo; Ali, Wesam Nashat

doi:10.2147/jpr.s163975

Cited by 16 publications

(13 citation statements)

References 43 publications

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“…Patients receiving epidural dexmedetomidine (0.1 µg/kg) as a loading dose and a continuous infusion of 0.15% ropivacaine at 2 ml/h combined with dexmedetomidine (1 µg/kg in 100 ml of 0.15% ropivacaine) following cesarean section under epidural anesthesia reported insufficient analgesia, with a VAS score >3, whether at rest or while coughing, at 12 and 24 h after surgery (8). Sufficient pain relief was attained in patients undergoing abdominal cancer surgery who received a bolus dose of 6 ml of 0.1% bupivacaine plus 0.5 µg/ml dexmedetomidine, followed by a continuous epidural infusion of 6 ml/h of 0.1% bupivacaine plus 0.5 µg/ml dexmedetomidine throughout the surgical period, continued for 48 h post-operatively (28). Zhang and Li (9) reported that the optimal dose of dexmedetomidine is 4 µg in 0.1% ropivacaine (8 ml) as a loading dose, and an hourly infusion dose for epidural labor analgesia.…”

Section: Discussionmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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The aim of the present study was to evaluate the effectiveness and safety of the combination of epidural dexmedetomidine and morphine in providing anesthesia during cesarean surgery and analgesia for post-cesarean pain relief when added to epidural ropivacaine. A total of 80 females at term scheduled for elective cesarean delivery were randomly assigned to two groups (n=40/group): In the morphine group (group M), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) for surgical anesthesia, and epidural infusion of morphine (2 mg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia; and in the morphine combined with dexmedetomidine group (group DM), patients received an epidural injection of 0.75% ropivacaine (12 ml) and morphine (2 mg) combined with dexmedetomidine (0.5 µg/kg) for surgical anesthesia, and epidural infusion of morphine (2 mg) and dexmedetomidine (200 µg) in 100 ml 0.2% ropivacaine at 2 ml/h for 48-h post-operative analgesia. The primary outcomes included blockade and analgesic effects, sedation and adverse reactions associated with the drugs. Neonatal outcome was also assessed by determining the Apgar score and umbilical cord blood analysis. There was no significant difference between the groups in the cephalad levels of sensory blockade at 20 min post-injection, or in muscle relaxation scores or pain intensity scores at rest or upon movement at 4, 12, 24 or 48 h post-injection (P>0.05). The maternal patients in the DM group experienced more complete motor blockade at 20 min post-injection, better sedation during surgery and following delivery, and less visceral pain caused by peritoneal traction during surgery and by uterine contraction after delivery, compared with those in group M (P<0.05). The patients in group M had a lower incidence and severity score of post-operative nausea than those in the DM group (P<0.05). There was no significant difference between the groups in terms of Apgar score or umbilical cord blood gas values (P>0.05). In conclusion, epidural dexmedetomidine reduces intra-operative and post-operative visceral pain and produces better sedation during surgery and following delivery, without any significant influence on morphine-associated side effects and post-operative analgesia, in females undergoing elective cesarean section under epidural anesthesia with morphine and ropivacaine (registration number ChiCTR1900027942; retrospectively registered with the Chinese Clinical Registry Center on December 6, 2019).

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Section: Discussionmentioning

confidence: 99%

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Yang

Song

et al. 2020

Exp Ther Med

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“…An increase in the dose of bupivacaine reduces the intensity of postoperative pain, reduces the opiate administration time to first analgesic demand, and decreases the incidence of nausea and vomiting (8). Intrathecal injection of alpha 2 agonists, such as dexmedetomidine, as adjuncts to topical anesthetics, can enhance the effects of anesthetic drugs and reduce their demand (5, 9-11). Dexmedetomidine as an adjunct directly increases the block time through the direct modulating of receptors on motor neurons and posterior horn sensory neurons of the spinal cord or their synapses (12, 13).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial

et al. 2019

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BackgroundEpidural block approach and drugs are common options for improving the sensory and motor block duration and postoperative pain management.ObjectivesThe study aimed to compare the analgesic effects of dexmedetomidine and morphine as adjuvants to bupivacaine for epidural anesthesia in leg fracture surgery.MethodsThis prospective clinical trial was conducted on patients (n = 80, age range: 18 - 60 years) categorized as ASA class I or II. After a clinical examination, the patients were allocated to receive either lumbar epidural bupivacaine + morphine (BM) (12 mL bupivacaine 0.5% + morphine 2 mg) or bupivacaine + dexmedetomidine (BD) (12 mL bupivacaine 0.5% + dexmedetomidine 1 µg/kg). After drug administration, the sensory block level was assessed at 2-min intervals using the Cold Swab method until it reached the T12 level. At the T12 level of sensory block, the surgery began when motor block reached grade 3 of the modified Bromage scale.ResultsThe BD group had a significantly shorter time to reach the sensory and motor block than the BM group (P < 0.001). The duration of sensory and motor block was significantly longer in the group BD than in the BM group (P < 0.001). Moreover, the BD group showed lower VAS scores (P < 0.0001) and longer time to first analgesia demand than the BM group.ConclusionsCombined bupivacaine + dexmedetomidine prolongs the sensory and motor block duration and controls postoperative pain more effectively, indicating that it is an appropriate combination for epidural anesthesia.

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“…Hetta et al [14] conducted a study that compared continuous infusions (48 hours) of epidural bupivacaine 0.1% versus bupivacaine 0.1% with dexmedetomidine 0.5 μg/ mL in patients undergoing abdominal cancer surgery and concluded that the addition of dexmedetomidine in epidural route significantly reduced the morphine consumption, delayed time to first rescue analgesia, and reduced pain scores during postoperative 48 hours [14]. In another study on 100 patients undergoing lower limb surgery, dexmedetomidine was compared with fentanyl as an epidural adjuvant and showed better hemodynamic stability, prolonged postoperative analgesia, and better sedation levels [15].…”

Section: Discussionmentioning

confidence: 99%

Influence of Epidural Ropivacaine with or without Dexmedetomidine on Postoperative Analgesia and Patient Satisfaction after Thoraco-Lumbar Spine Instrumentation: A Randomized, Comparative, and Double-Blind Study

et al. 2021

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This was a prospective, randomized, and double-blind study. Purpose: Thoraco-lumbar spine surgery is associated with severe postoperative pain and can cause chronic pain. We aimed to compare the impact of epidural ropivacaine with and without dexmedetomidine on postoperative analgesia after thoracolumbar spine instrumentation wherein an epidural catheter was placed by the surgeon intraoperatively. Overview of Literature: Very few studies have reported the use of epidural dexmedetomidine in spine surgeries. When used via the epidural route, dexmedetomidine is safe and efficacious and is associated with reduced rescue analgesia consumption, increased duration of analgesia, reduced pain scores, but not with major hemodynamic adverse effects. Methods: Total 60 American Society of Anesthesiologists I-III adult patients aged 18-65 years who were scheduled to undergo thoraco-lumbar spine instrumentation were randomly allocated into group RD (epidural ropivacaine+dexmedetomidine) or group R (epidural ropivacaine plus saline). We aimed to compare the total rescue analgesic consumption on postoperative day 0, 1, and 2. Moreover, we studied the time to first rescue analgesia with visual analogue scale score <4 and the overall patient satisfaction scores. Results: There was no difference between the demographic characteristics of the two groups. The mean value of total rescue analgesia consumption was 162.5±68.4 mg in the RD group and 247.5±48.8 mg in the R group. The mean time to first rescue analgesia was 594.6±83.0 minutes in the RD group and 103.6±53.2 minutes in the R group. The mean patient satisfaction score was 4.2±0.7 in the RD group and 3.2±0.6 in the R group. No patient had any respiratory depression or prolonged motor blockade during the postoperative period. Conclusions: This study demonstrated the superior efficacy, in terms of postoperative analgesia and patient satisfaction scores, of epidural ropivacaine plus dexmedetomidine over that of ropivacaine alone in patients undergoing surgery for thoraco-lumbar spine.

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Epidural dexmedetomidine infusion for perioperative analgesia in patients undergoing abdominal cancer surgery: randomized trial

Cited by 16 publications

References 43 publications

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Addition of dexmedetomidine to epidural morphine to improve anesthesia and analgesia for cesarean section

Comparison of Dexmedetomidine and Morphine as Adjuvants to Bupivacaine for Epidural Anesthesia in Leg Fracture Surgery: A Randomized Clinical Trial

Influence of Epidural Ropivacaine with or without Dexmedetomidine on Postoperative Analgesia and Patient Satisfaction after Thoraco-Lumbar Spine Instrumentation: A Randomized, Comparative, and Double-Blind Study

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