Survey on sedation-analgesia regimens, in particular the use of dexmedetomidine, among Dutch implanters of spinal cord neurostimulators

Abstract

Background and aims During implantation of most spinal cord neurostimulators, patients need to be cooperative to give feedback during lead placement, and also be comfortable. Sedation and analgesia can support these conditions. This survey aimed to provide an overview of the sedation-analgesia regimens currently used among Dutch pain specialists. The survey focused on the sedative agent “dexmedetomidine” due to its attractive pharmacological profile and its promising results during awake procedures. Methods A 27-item survey was sent to the 65 pain specialists involved in neurostimulation in the Netherlands. The survey consisted of questions related to different aspects of sedation and analgesia during neurostimulation, e.g. the current regimen, the opinion on and experience with dexmedetomidine as a sedative agent, and preferences regarding different aspects of sedation (i.e. production of arousable sedation, pain management, quality of patient’s feedback and overall preference). Results Of 65 pain specialists, 45 (69%) completed the survey. Most commonly used sedative was propofol (91%) and most common used analgesic was remifentanil (78%). Of the 45 respondents, 21 (47%) considered the use of dexmedetomidine, whereas 13 (29%) had experience with dexmedetomidine during neurostimulation. The most frequently mentioned positive property of dexmedetomidine was the easy production of arousable sedation. Most respondents who used dexmedetomidine preferred dexmedetomidine sedation over propofol sedation regarding all aspects of sedation. Conclusions The most commonly used sedation-analgesia regimen is the combination of propofol-remifentanil during the implantation of a neurostimulator among Dutch pain specialists. Only a small percentage of respondents had experience with the use of dexmedetomidine, despite its reported advantages. Implications When implanting a spinal cord neurostimulator, dexmedetomidine could be considered as a sedative, given its allowance for and preservation of a state of easy arousable sedation.

Long-Term Effects of Dexmedetomidine versus Propofol During the Implantation of a Neurostimulator—A Post-Trial Follow-Up Analysis

“…The most commonly used sedation-analgesia regimen during a neurostimulation procedure in the Netherlands is the combination of propofol-remifentanil. 6 Propofol is frequently used partly because anesthesiologists have much experience with it. It provides a smooth and rapid induction and easily controllable and stable continuation of sedation, and its cost is relatively low.…”