CONSORT the effect of a bolus dose of dexmedetomidine on postoperative pain, agitation, and quality of recovery after laparoscopic cholecystectomy

Abstract

Background: The perioperative administration of dexmedetomidine may improve the quality of recovery (QoR) after major abdominal and spinal surgeries. We evaluated the effect of an intraoperative bolus of dexmedetomidine on postoperative pain, emergence agitation, and the QoR after laparoscopic cholecystectomy. Methods: Patients undergoing elective laparoscopic cholecystectomy were randomized to receive dexmedetomidine 0.5 μg/kg 5 minutes after anesthesia induction (dexmedetomidine group, n = 45) or normal saline (control group, n = 45). The primary outcome was the QoR at the first postoperative day using a 40-item scoring system (QoR-40). Secondary outcomes included intraoperative hemodynamic parameters, postoperative agitation, pain, and nausea and vomiting. Results: The heart rate and the mean blood pressure were significantly lower in the dexmedetomidine group than in the control group (P < .001 and .007, respectively). During extubation, emergence agitation was significantly lower in the dexmedetomidine group than in the control group (23% vs 64%, P < .001). The median pain scores in the post-anesthetic care unit were significantly lower in the dexmedetomidine group than in the control group (4 [2–7] vs 5 [4–7], P = .034). The incidence of postoperative agitation, pain, and nausea and vomiting was not different between the groups. On the first postoperative day, recovery profile was similar between the groups. However, the scores on the emotional state and physical comfort dimensions were significantly higher in the dexmedetomidine group than in the control group (P = .038 and .040, respectively). Conclusions: A bolus dose of dexmedetomidine after anesthesia induction may improve intraoperative hemodynamics, emergence agitation, and immediate postoperative analgesia. However, it does not affect overall QoR-40 score after laparoscopic cholecystectomy.

The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis

“…The overall risk of bias for our primary outcome was low for 10 (30%) studies, 42,45,46,51,58,62,63,66,67,72 and the rest were considered to have some concerns. All studies had satisfactory discussion or documentation regarding missing outcome data.…”

“…There were 33 RCTs with 2676 patients included in this review, and the PRISMA flow diagram 41 is displayed in Figure 1. 42–74 All but 8 RCTs 43,49,50,52,54,64,65,74 included at least 1 secondary outcome. Seven studies 46,55,57,62,68,69,71 premedicated their patients with benzodiazepines.…”

“…The other study 55 provided analgesia either after meeting a pain score or on patient request. Of the 6 studies, 4 47,55,66,68 measured pain with visual analog scale and 2 45,53 numerical rating scale. Moderate-certainty evidence from 6 studies indicated that dexmedetomidine significantly reduced the relative risk of incidence of clinically significant pain in PACU by 50% when compared to placebo (RR, 0.50; 95% CI, 0.32-0.80; P = .003; I 2 = 10%).…”

Analgesic effect of dexmedetomidine in colorectal cancer patients undergoing laparoscopic surgery

“…11,12 Reportedly, DEX diminishes the catecholamine levels by decreasing the sympathetic nervous system activity and provide hemodynamic stability during surgery. 13 Dexmedetomidine has been used as a sub-anesthetic and anxiolytic agent; however, of late, DEX has been found to have an antinociceptive effect, thus broadening its usage in acute and chronic pain conditions. Perioperative administration of DEX has been shown to have superior analgesic and opioidsparing effects in several surgeries.…”

A Dose-Response Relationship Study of Prophylactic Nalbuphine to Reduce Pain During the Awakening Period in Patients Undergoing Laparoscopic Total Hysterectomy: A Randomized, Controlled, Double-Blind Clinical Study

“…However, surgical incisions, CO 2 pneumoperitoneum, and remifentanil-induced hyperalgesia (RIH) can lead to pain and agitation during the awakening period, 5 , 6 which not only makes anesthesia management more difficult but also renders patients susceptible to unintentional injury. 7 Studies have shown that patients treated with gynecological laparoscopy are up to 80% more likely to experience post-procedural pain. 8 , 9 …”