Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control

Abstract

We aimed to compare fentanyl, remifentanil and dexmedetomidine with respect to hemodynamic stability, postoperative pain control and achievement of sedation at the postanesthetic care unit (PACU). In this randomized double-blind study, 90 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive fentanyl (1.0 µg/kg) over 1 minute followed by a 0.4 µg/kg/hr infusion (FK group, n = 30), or remifentanil (1.0 µg/kg) over 1 minute followed by a 0.08 µg/kg/min infusion (RK group, n = 30), or dexmedetomidine (1 µg/kg) over 10 minutes followed by a 0.5 µg/kg/hr infusion (DK group, n = 30) initiating at the end of main procedures of the operation to the time in the PACU. A single dose of intravenous ketorolac (30 mg) was given to all patients at the end of surgery. We respectively evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs and the perioperative side effects to compare the efficacy of fentanyl, remifentanil and dexmedetomidine. Compared with other groups, the modified OAA/S scores were significantly lower in DK group at 0, 5 and 10 minutes after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different from other groups. The blood pressure and heart rate in the DK group were significantly lower than those of other groups at the PACU (P < 0.05). DK group, at sedative doses, had the better postoperative hemodynamic stability than RK group or FK group and demonstrated a similar effect of pain control as RK group and FK group with patient awareness during sedation in the PACU. (World Health Organization registry, KCT0001524).

<p>Effects of Additional Intraoperative Administration of Sufentanil on Postoperative Pain, Stress and Inflammatory Responses in Patients Undergoing Laparoscopic Myomectomy: A Double-Blind, Randomized, Placebo-Controlled Trial</p>

“…35,36 Favorable postoperative pain management makes for adequate analgesia and sedation. [37][38][39] Our present study showed attenuated agitation as demonstrated by significantly reduced SAS score in the group T compared with group C, which was in line with our results of the postoperative pain score, indicating that additional intraoperative administration of sufentanil is helpful for proper postoperative pain management in patients undergoing laparoscopic myomectomy. The release of stress factors and inflammatory mediators caused by surgical or anesthetic operations may directly cause pain and affect patients' postoperative recovery.…”

Intra‐operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta‐analysis with trial sequential analysis

“…). Sub‐group analyses according to the type of medication used for anaesthetic maintenance suggested a similar effect in both the volatile anaesthetic (mean difference (95%CI): 0.6 (0.0–1.1); I 2 = 87%; p = 0.05) and propofol sub‐groups (mean difference (95%CI): 1.3 (0.7, 1.8); I 2 = 85%; p < 0.0001), with no difference between sub‐groups (p = 0.05). With regard to the funnel plots for our primary outcome, the Duval and Tweedie's trim and fill test revealed the point estimates (95%CI) for the combined studies to be −0.48 (−0.64 to −0.32); using trim and fill, these values are unchanged, suggesting that no trials are missing from the meta‐analysis.…”

“…All studies included a total of patients ranging from 30 to 88, with the exception of one study that included a total of 139 patients . Nine trials included patients scheduled for laparoscopic surgery , seven for ear, nose and throat surgery , and five for different types of elective operations . Fourteen (66%) included trials used volatile anaesthetic to maintain anaesthesia and seven that administered propofol .…”

Postoperative pain management in the postanesthesia care unit: an update

“… 70 IV DEX at sedative doses initiated at the end of main procedures of the surgery to the time in the PACU resulted in better postoperative hemodynamic stability than fentanyl or remifentanil with a similar effect of pain control in the PACU. 71 DEX as an intrathecal adjuvant with ropivacaine for spinal anesthesia provided better postoperative analgesia after infraumbilical surgeries as compared with MgSO 4 . 72 DEX as an epidural adjuvant had a greater analgesic and local anesthetic-sparing effect, compared with fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery.…”