Impact of intravenous dexmedetomidine on gastrointestinal function recovery after laparoscopic hysteromyomectomy: a randomized clinical trial

Abstract

Postoperative intestinal ileus is common after laparoscopic surgery, the incidence of those after hysterectomy was 9.2%. Anesthesia is one of the independent risk factors of postoperative ileus. Dexmedetomidine has been widely used in perioperative anesthesia and previous reports suggested that intraoperative dexmedetomidine may be associated with the improvement of gastrointestinal function recovery after abdominal surgery. We hypothesized that dexmedetomidine could improve gastrointestinal function recovery after laparoscopic hysteromyomectomy. Participants in elective laparoscopic hysteromyomectomy were enrolled with a single dose of 0.5 μg kg−1 dexmedetomidine or the same volume of placebo intravenously administered for 15 min, followed by continuous pumping of 0.2 μg kg−1 h−1 of corresponding drugs until 30 min before the end of surgery. The primary outcome was the time to first flatus. Secondary outcomes were the time to first oral feeding and the first defecation, the occurrence of flatulence, pain score and postoperative nausea and vomiting until 48 h after the surgery. Eventually, 106 participants (54 in dexmedetomidine group and 52 in placebo group) were included for final analysis. The time to first flatus (SD, 25.83 [4.18] vs 27.67 [3.77], P = 0.019), oral feeding time (SD, 27.29 [4.40] vs 28.92 [3.82], P = 0.044), the time to first defecation (SD, 59.82 [10.49] vs 63.89 [7.71], P = 0.025), abdominal distension (n%, 12 (22.2) vs 21 (40.4), P = 0.044), PONV at 24 h (n%, 10 (18.5) vs 19 (36.5), P = 0.037), NRS 6 h (3.15(0.68) vs 3.46 (0.87), P = 0.043) and NRS 12 h (3.43 (0.88) vs 3.85 (0.85), P = 0.014) of dexmedetomidine group were significantly shorter than those of the placebo group. Intraoperative dexmedetomidine reduced the time to first flatus, first oral feeding, and first defecation. These results suggested that this treatment may be a feasible strategy for improving postoperative gastrointestinal function recovery in patients undergoing laparoscopic hysteromyomectomy.

Effects of Dexmedetomidine on Systemic Inflammation and Postoperative Complications in Laparoscopic Pancreaticoduodenectomy: A Double‐blind Randomized Controlled Trial

“…Among mechanically ventilated patients with sepsis, sedation with DEX resulted in reduced inflammatory response and increased lactate clearance [ 46 , 47 ]. Intraoperative DEX reduced the time to first flatus, first oral feeding, and first defecation [ 48 ].These results showed that this treatment may be a feasible strategy for improving postoperative gastrointestinal function recovery in patients undergoing laparoscopic operation. With agreement, our results showed that the incidences of major postoperative complications including POPF, delayed gastric emptying and severe intra-abdominal infection were reduced in the DEX group though there were no statistical significance, which means further research is urgently needed.…”

“…Among mechanically ventilated patients with sepsis, sedation with DEX resulted in reduced inflammatory response and increased lactate clearance [46, 47]. Intraoperative DEX reduced the time to first flatus, first oral feeding, and first defecation [48]. These results showed that this treatment may be a feasible strategy for improving postoperative gastrointestinal function recovery in patients undergoing laparoscopic operation.…”

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

“…4,5 Previous studies have shown that dexmedetomidine provides effective postoperative early analgesia and reduced postoperative opioid requirements for different types of surgeries. [6][7][8][9] Furthermore, a meta-analysis indicated that dexmedetomidine relieved postoperative acute pain intensity and reduced perioperative analgesic consumption in neurosurgery, but the impact of dexmedetomidine on chronic pain needs further study. 10 It has been reported that postoperative acute pain correlates with an increased risk of chronic pain.…”

Research progress on the effect of dexmedetomidine on ERAS

“…Published by Francis Academic Press, UK -43-support this view believe that dexmedetomidine can improve the activity of the vagus nerve, and then promote the peristalsis of the gastrointestinal tract. On this basis, the secretion function of the gastrointestinal tract is also enhanced, the digestive ability of food in the gastrointestinal tract is enhanced, and the desire to eat becomes more intense [27] . Scholars supporting another view believe that dexmedetomidine inhibited postoperative recovery of gastrointestinal function [28] .…”