Impact of dexmedetomidine supplemented analgesia on delirium in patients recovering from orthopedic surgery: A randomized controlled trial

Abstract

Background Dexmedetomidine promotes normal sleep architecture; the drug also improves analgesia. We therefore tested the hypothesis that supplementing intravenous analgesia with dexmedetomidine reduces delirium in older patients recovering from orthopedic surgery. Methods In this double-blinded randomized controlled trial, we enrolled 712 older (aged 65–90 years) patients scheduled for major orthopedic surgery. Postoperative analgesia was provided by patient-controlled intravenous sufentanil, supplemented by randomly assigned dexmedetomidine (1.25 μg/mL) or placebo, for up to three days. The primary outcome was the incidence of delirium assessed twice daily with the Confusion Assessment Method. Among secondary outcomes, pain severity was assessed twice daily and sleep quality once daily, each with an 11-point scale where 0 = no pain/the best possible sleep and 10 = the worst pain/the worst possible sleep. Results The incidence of postoperative delirium was 7.3% (26 of 354) with placebo and 4.8% (17 of 356) with dexmedetomidine; relative risk 0.65, 95% CI 0.36 to 1.18; P = 0.151. Dexmedetomidine reduced pain both at rest (median difference -1 to 0 points, P ≤ 0.001) and with movement (-1 points, P < 0.001) throughout the first 5 postoperative days; it also improved subjective sleep quality during the first 3 postoperative days: day one median difference -1 point (95% CI -1 to 0), P = 0.007; day two 0 point (-1 to 0), P = 0.010; and day three 0 point (-1 to 0), P = 0.003. The incidence of adverse events was similar in each group. Conclusions Supplementing sufentanil intravenous analgesia with low-dose dexmedetomidine did not significantly reduce delirium, but improved analgesia and sleep quality without provoking adverse events. Trial registration www.chictr.org.cn: ChiCTR1800017182 (Date of registration: July 17, 2018); ClinicalTrials.gov:NCT03629262 (Date of registration: August 14, 2018).

The effects of dexmedetomidine for patient-controlled analgesia on postoperative sleep quality and gastrointestinal motility function after surgery: A prospective, randomized, double-blind, and controlled trial

“…This randomized clinical trial investigated the effect of 0, 200, and 400 μg of DEX combined with sufentanil for PCA on postoperative sleep quality and the recovery of gastrointestinal motility function in patients after colorectal cancer surgery. Our results demonstrated that the continuous infusion of 200 and 400 μg of DEX for PCA after surgery improves sleep quality in the Studies have shown that DEX used for PCA at a rate of 0.03 μg/kg/h improves postoperative sleep quality (Chen et al, 2017;Hong et al, 2021). The total dosage of DEX used in this study was 0.03-0.05 and 0.07-0.09 μg/kg/h according to the body weight of enrolled patients in the DEX 200 μg group and DEX 400 μg group, respectively, which was higher than that used in the above report.…”

“…Studies have shown that DEX used for PCA at a rate of 0.03 μg/kg/h improves postoperative sleep quality ( Chen et al, 2017 ; Hong et al, 2021 ). The total dosage of DEX used in this study was 0.03–0.05 and 0.07–0.09 μg/kg/h according to the body weight of enrolled patients in the DEX 200 μg group and DEX 400 μg group, respectively, which was higher than that used in the above report.…”

Effect of low-dose dexmedetomidine on sleep quality in postoperative patients with mechanical ventilation in the intensive care unit: A pilot randomized trial

“…In our previous studies, low-dose dexmedetomidine infusion at night improved sleep quality without increasing adverse events in postoperative ICU patients, the majority of whom did not receive invasive mechanical ventilation ( 22 , 23 ). Subsequent studies showed that low-dose dexmedetomidine combined with opioids also improves analgesia and subjective sleep quality ( 43 , 44 ). Chen et al ( 45 ) reported that dexmedetomidine administered at a rate of 0.05–0.08 μg/kg/h via a patient-controlled analgesia pump improved the sleep structure ( 45 ).…”

Perioperative neurocognitive disorders: A narrative review focusing on diagnosis, prevention, and treatment

“…205 Dexmedetomidine supplemented analgesia may also reduce delirium but requires further investigation. 206…”

“…It is worthy to note that an even lower dose of dexmedetomidine, such as used as an adjuvant in the patient‐controlled analgesia pump, also improves sleep quality after surgery 205 . Dexmedetomidine supplemented analgesia may also reduce delirium but requires further investigation 206 …”