Perioperative Dexmedetomidine or Lidocaine Infusion for the Prevention of Chronic Postoperative and Neuropathic Pain After Gynecological Surgery: A Randomized, Placebo-Controlled, Double-Blind Study

Abstract

Introduction:The transition of acute to chronic postoperative pain (CPP) remains a significant burden to the rehabilitation of patients. The research for adjuvants to prevent CPP continues; among others, dexmedetomidine and lidocaine seem promising agents. Methods: This is a long-term follow-up of a randomized, placebo-controlled, double-blind study on women who underwent open abdominal gynecological surgery and received dexmedetomidine or lidocaine or placebo infusion perioperatively (n = 81). The effect of these adjuvants on the development of CPP and neuropathic pain was assessed during a 12-month follow-up. Eighty-one (81) women ASA I-II, aged between 30 and 70 years, were randomly assigned to receive either dexmedetomidine (DEX group) or lidocaine (LIDO group) or placebo (CONTROL group) perioperatively. Before anesthesia induction, all patients received a loading intravenous dose of either 0.6 lg/kg dexmedetomidine or 1.5 mg/kg lidocaine or placebo, followed by 0.6 lg/kg/h dexmedetomidine or 1.5 mg/kg/h lidocaine or placebo until last suture. Patients were followed up to obtain the long-term outcomes at 3, 6, and 12 months. At these time-points, pain intensity was assessed with the Numerical Rating Scale, (NRS: 0-10) and the development of neuropathic elements with the Douleur Neuropathique 4 (DN4) score. Prognostic parameters that could affect chronic pain and its components were also identified. Results: Data from 74 women were analyzed. Dexmedetomidine significantly reduced NRS scores comparing to placebo at 3 months (p = 0.018), while at 6 months, lidocaine was found superior to placebo (p = 0.02), but not to dexmedetomidine, in preventing neuropathic pain (DN4 \ 4). Regarding secondary endpoints, higher NRS cough scores at 48 h were associated with statistically significant NRS and DN4 scores at 3, 6, and 12 months (p \ 0.02). At 6 months, a statistically significant correlation was also found between higher NRS values and older age (p = 0.020). Conclusions: Dexmedetomidine was superior to placebo regarding the duration and severity

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

“…However, the difference was small and may be of limited clinical importance. Ours differs from a study by Rekatsina et al, 31 which showed that dexmedetomidine significantly reduced pain scores, but did not reduce the incidence of neuropathic pain (Douleur Neuropathique 4 score >4). This inconsistency may be due to the different diagnostic scales of neuropathic pain used and the sample size.…”

“…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.…”

Effect of Dexmedetomidine on Postpartum Depression in Women With Prenatal Depression

“…Dexmedetomidine is commonly used as an adjuvant analgesic in clinical practice and has a good synergistic effect with opioids without causing respiratory depression . The unremarkable improvement in pain on movement can be attributed to the dose we administered (0.04 μg/kg/h), which is much lower compared with the standard clinical dose (0.6 μg/kg/h) …”

Risk factors for chronic postsurgical pain in visceral surgery: a matched case–control analysis

“…Dexmedetomidine, a highly selective α2 adrenoreceptor agonist, reduces postoperative pain and opioid use in the acute phase [ 29 ]. In a prospective study, it was also associated with significantly less CPSP [ 30 ]. In our study, the use of dexmedetomidine peri- and postoperatively was significantly lower in the CPSP group but is not significant in the multivariate analysis.…”