The Effect of Dexmedetomidine on Postoperative Opioid Consumption and Pain After Major Spine Surgery

Naik, Bhiken I.; Nemergut, Edward C.; Kazemi, Ali; Fernández, Lucas G.; Cederholm, Sarah K.; McMurry, Timothy L.; Durieux, Marcel E.

doi:10.1213/ane.0000000000001226

Cited by 61 publications

(40 citation statements)

References 26 publications

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“…In fact, the study was terminated after an interim analysis for futility as the estimated sample size was insufficient to show a difference in opioid consumption postoperatively. Interestingly, this study also compared the intraoperative opioid requirements, administered as fentanyl boluses similar to our study, and observed a statistically significant decrease by 50%: median [IQR] of 3.5 [0‐11] versus 7 [3‐15] in dexmedetomidine versus saline group, respectively, P = 0.04 . It is likely that differences in patient population impacts the effects of dexmedetomidine on postoperative analgesia apart from possible study related differences due to sample size and bias.…”

Section: Discussionsupporting

confidence: 71%

“…Use of non‐inferiority designs can also have inherent limitations such as no internal demonstration of assay sensitivity, lack of single conservative analysis approach, and difficulty in specifying the non‐inferiority margin . Our non‐inferiority margin of 0‐100 µg can be considered appropriate as Naik et al observed that a median dose of 350 µg of fentanyl was used in their study comparing dexmedetomidine versus saline . Another study also observed a median difference in intraoperative fentanyl requirement of 150 µg to be non‐inferior between paravertebral block with propofol group and general anaesthesia group …”

Section: Discussionmentioning

confidence: 92%

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Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

et al. 2019

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Background: Moderate to severe pain is common despite the use of potent opioids during craniotomies. Non-opioid agents such as dexmedetomidine reduce undesirable opioid effects and are successfully used as primary analgesic during bariatric surgeries. This study assessed the feasibility of conducting a large randomised controlled trial comparing fentanyl with dexmedetomidine for perioperative analgesia during craniotomy. Methods:This was a prospective single-centre randomised controlled feasibility trial.Twenty-four consenting adult patients undergoing supratentorial craniotomy at NIMHANS, Bangalore, India, were recruited after ethical approval in March and April 2018. They received either fentanyl 1 µg kg −1 h −1 (n = 12) or dexmedetomidine 0.5 µg kg −1 h −1 (n = 12) as primary intraoperative analgesic drug. Patient, anaesthesiologist, outcome assessor and data analyst were blinded to the study intervention.Our feasibility outcomes (primary) were recruitment and adherence rates. We also explored the potential efficacy of intervention and adverse events. Results:We recruited 24 out of 30 eligible patients and had 100% protocol adherence, thereby demonstrating the feasibility of a larger randomised controlled trial. All 24 patients completed the study. The demographic and clinical parameters were similar between the groups. Compared between fentanyl and dexmedetomidine, there was no difference in the intraoperative fentanyl (top-up) consumption (µg), expressed as median and interquartile range: 25 (0-50) and 0 (0-50); P = 0.844; and no difference in postoperative pain at 15 and 60 minutes. Adverse events were few and similar with fentanyl and dexmedetomidine. Conclusions:A large-scale randomised controlled trial of perioperative dexmedetomidine versus fentanyl is feasible. Dexmedetomidine has the potential to be non-inferior to fentanyl for perioperative analgesia during craniotomies.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 92%

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

et al. 2019

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“…16,18,27 Identification and treatment of high-risk patients via psychological screening prior to surgery may provide benefit for postoperative recovery. Recently, Caumo et al developed a brief measure of emotional preoperative stress (B-MEPS) to aid clinicians in identifying patients at risk for developing moderate to severe pain postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

Dunn¹,

Durieux

Fernández³

et al. 2018

Journal of Neurosurgery: Spine

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126

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OBJECTIVEPerception of perioperative pain is influenced by various psychological factors. The aim of this study was to determine the impact of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain scores, and quality of recovery in adults who underwent spine surgery.METHODSPatients undergoing spine surgery were enrolled in this study, and the preoperatively completed questionnaires included the verbal rating scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Quality of recovery was assessed using the 40-item Quality of Recovery questionnaire (QoR40). Opioid consumption and pain scores according to the VRS were recorded daily until discharge.RESULTSOne hundred thirty-nine patients were recruited for the study, and 101 completed the QoR40 assessment postoperatively. Patients with higher catastrophizing scores were more likely to have higher maximum pain scores postoperatively (estimate: 0.03, SE: 0.01, p = 0.02), without increased opioid use (estimate: 0.44, SE: 0.27, p = 0.11). Preoperative anxiety (estimate: 1.18, SE: 0.65, p = 0.07) and depression scores (estimate: 1.06, SE: 0.71, p = 0.14) did not correlate with increased postoperative opioid use; however, patients with higher preoperative depression scores had lower quality of recovery after surgery (estimate: −1.9, SE: 0.56, p < 0.001).CONCLUSIONSCatastrophizing, anxiety, and depression play important roles in modulating postoperative pain. Preoperative evaluation of these factors, utilizing a validated tool, helps to identify patients at risk. This might allow for earlier psychological intervention that could reduce pain severity and improve the quality of recovery.

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“…Agonism of this alpha receptor induces multiple downstream effects including a decrease in sympathetic tone, attenuation of the neuroendocrine and hemodynamic response to surgery, reductions in anesthetic and opioid requirements, and induction of sedation and analgesia. There have been several studies assessing its benefit for postoperative analgesia when used during the perioperative period with mixed results [83][84][85][86][87][88][89][90][91][92][93][94][95][96]. However, many studies have demonstrated reduce postoperative opioid use when the drug is administered intraoperatively, specifically following laryngectomy [83], abdominal surgeries [84,95], bariatric surgery [91,96], cesarean section [86], off-pump coronary artery bypass surgery [87], knee surgery [88,94], tonsillectomy [90], and total abdominal hysterectomy [93].…”

Section: Dexmedetomidinementioning

confidence: 99%

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

Gabriel

Swisher

Sztain

et al. 2019

Expert Opinion on Pharmacotherapy

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Introduction: There are various important implications associated with poorly controlled postoperative pain in the adult surgical patientthis includes cardiopulmonary complications, opioid-related side effects, unplanned hospital admissions, prolonged hospital stay, and the subsequent development of chronic pain or opioid addiction. With the ongoing national opioid crisis, it is imperative that perioperative providers implement pathways for surgical patients that reduce opioid requirements and painrelated complications. Areas covered: In this review, the authors discuss the components of a multimodal opioid-sparing analgesia pathway as it pertains to the perioperative environment. Medications reviewed include gabapentinoids, acetaminophen, non-steroidal anti-inflammatory drugs, ketamine, intravenous lidocaine, dexmedetomidine, and glucocorticoids. The use of peripheral nerve blocks and neuraxial analgesia are also discussed. Expert opinion: In appropriate cases, regional anesthetic interventions are extremely useful for postoperative analgesia, including peripheral nerve blocks and neuraxial analgesia and while newer postoperative analgesics have been postulated, the literature on such is presently controversial. Coordinated approaches to pain management are recommended to reduce the need for opioids and to improve patient satisfaction post-surgery.

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The Effect of Dexmedetomidine on Postoperative Opioid Consumption and Pain After Major Spine Surgery

Abstract: Intraoperative dexmedetomidine does not reduce postoperative opioid consumption or improve pain scores after multilevel deformity correction spine surgery.

Cited by 61 publications

References 26 publications

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

Comparison of intraoperative fentanyl with dexmedetomidine for perioperative analgesia and opioid consumption during craniotomies: A randomised controlled pilot study with non‐inferiority design

Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

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