The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Abstract

Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and post-operative infusions of dexmedetomidine (DEX) plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery.Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg−1 for 10 min, then adjusted to 0.3 μg·kg−1·h−1 until incision suturing) and Group ND (no DEX infusion during surgery). Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg−1·h−1 plus DEX 0.02 μg·kg−1·h−1, Group ND: sufentanil 0.02 μg·kg−1·h−1) in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic, and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity [Visual Analogue Scale (VAS)], Ramsay sedation scale (RSS) and Bruggemann comfort scale (BCS) were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery.Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P < 0.05). Compared with Group ND, heart rate (HR) in Group D was significantly decreased from intubation to 20 min after arriving at post anesthesia care unit (PACU), while mean arterial pressure (MAP) in Group D was significantly decreased from intubation to 5 min after arriving at PACU (P < 0.05). The intraoperative requirements for sevoflurane, remifentanil, and fentanyl were approximately 35% less in Group D compared with Group ND. VAS at rest at 1, 4, and 8 h and with cough at 12, 24, 48, and 72 h after surgery were significantly lower in Group D (P < 0.05). Compared with Group ND, patients in Group D showed lower levels of overall incidence of tachycardia, hypertension, nausea, and vomiting (P < 0.05). There were no significant differences between the two groups in terms of baseline clinical characteristics, recovery time, RSS, and BCS (P > 0.05).Conclusions: DEX (0.02 μg·kg−1·h−1) plus sufentanil (0.02 μg·kg−1·h−1) could reduce postoperative opioid consumption and concerning adverse adverse effects, while improving pain scores. However, it did not influence RSS and BCS during the first 72 h after neurosurgery.

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

“…The only study evaluating remifentanil with dexmedetomidine for perioperative analgesia during neurosurgery did not evaluate intraoperative opioid requirements and postoperative pain scores, thereby making it difficult to compare with our study . Many earlier studies having dexmedetomidine in the anaesthetic regimen used it as a co‐analgesic rather than as a sole analgesic . In non‐craniotomy surgeries, non‐opioid intravenous techniques have shown similar analgesic effects with fewer complications .…”

“…Previous studies have noted comparable analgesia with non‐opioid analgesics such as ketamine, dexmedetomidine and lignocaine alone or in combination when compared with opioids in bariatric and laparoscopic surgeries . For neurosurgical procedures, addition of dexmedetomidine to an opioid‐based technique resulted in less adverse effects and reduction in anaesthetic and perioperative opioid consumption . Currently, there is no evidence to support the use of dexmedetomidine as a primary analgesic during craniotomies.…”

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Combined with Oxycodone Infusion during Open Hepatectomy: A Randomized Controlled Trial

“…However, some side effects such as nausea, vomiting, and respiratory depression have also been reported ( Koch et al, 2008 ). A multimodal analgesia that could enhance analgesia and reduce the requirement for opioids would be productive ( Su et al, 2016 ).…”

“…Therefore, one of the most beneficial interventions need to investigate is the reduction of pain intensity and opioid consumption by an adjunct drug combined with an opioid. Some adjunct drugs have the protective and opioid-sparing effects, such as ketamine, ketorolac, N -methyl- D -aspartate antagonists, and α 2 adrenergic receptor agonists ( Lin et al, 2009 ; White et al, 2012 ; Su et al, 2016 ). Dexmedetomidine (DEX), a highly selective α 2 adrenergic receptor agonist, was used and studied as an important analgesic adjunct drug during the perioperative time of surgery.…”

“…Many studies have reported the opioid-sparing analgesic effects of DEX, either combination with opioids for a continuous infusion intraoperatively or post-operative analgesia ( Su et al, 2016 ). However, no studies have concentrated on the analgesic effects of DEX and oxycodone during open abdominal surgery.…”