Dexmedetomidine administration during brain tumour resection for prevention of postoperative delirium: a randomised trial

Li, Shu; Li, Ruowen; Li, Muhan; Cui, Qianyu; Zhang, Xingyue; Ma, Tingting; Wang, Dexiang; Zeng, Min; Li, Hao; Bao, Zhaoshi; Peng, Yuming; Sessler, Daniel I.

doi:10.1016/j.bja.2022.10.041

Cited by 20 publications

(13 citation statements)

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“…23,24 The low incidence and mild severity of chronic incisional pain might be explained by the analgesia protocol of this trial compared to other studies because the current study was originally designed to study delirium and minimize postoperative pain. 13 To primarily explore the impact of dexmedetomidine on postoperative delirium, we applied scalp nerve block, intraoperative opioids, and postoperative patient-controlled analgesia to reduce the effect of acute pain on delirium. 25 Moreover, scalp nerve block was applied to inhibit inflammation, central sensitization, and development of neuropathic pain after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This investigator-initiated, randomized, double-blind, placebo-controlled study was originally designed to examine the effect of dexmedetomidine on delirium after neurosurgery. 13 The study was registered at www.ClinicalTrials.gov on December 19, 2020 (NCT04674241, principal investigator: Yuming Peng, date of registration: December 19, 2020) before patient enrollment. The study was approved by the Ethics Committee at both local institutions where it was performed, and all participants provided written informed consent before enrollment.…”

Section: Methodsmentioning

confidence: 99%

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Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Zeng,

Xu,

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Dexmedetomidine was reported to reduce postoperative acute pain after neurosurgery. However, the efficacy of dexmedetomidine for preventing chronic incisional pain is uncertain. METHODS: This article is a secondary analysis of a randomized, double-blind, placebo-controlled trial. Eligible patients were randomly allocated to either the dexmedetomidine group or the placebo group. Patients assigned to the dexmedetomidine group were given a 0.6 μg kg −1 dexmedetomidine bolus followed by a 0.4 μg kg −1 h −1 maintenance dose until dural closure; placebo patients were given comparable amounts of normal saline. The primary end point was the incidence of incisional pain at 3 months after craniotomy evaluated by numerical rating scale scores and defined as any score >0. The secondary end points were postoperative acute pain scores, sleep quality, and Short-Form McGill Pain Questionnaire (SF-MPQ-2) at 3 months after craniotomy. RESULTS: From January 2021 to December 2021, a total of 252 patients were included in the final analysis: the dexmedetomidine group (n = 128) and the placebo group (n = 124). The incidence of chronic incisional pain was 23.4% (30 of 128) in the dexmedetomidine group versus 42.7% (53 of 124) in the placebo group (risk ratio, 0.55; 95% confidence interval, 0.38-0.80; P = .001). The overall severity of chronic incisional pain was mild in both groups. Patients in the dexmedetomidine group had lower acute pain severity on movement than those in the placebo group for the first 3 days after surgery (all adjusted P < .01). Sleep quality did not differ between groups. However, the SF-MPQ-2 total sensory (P = .01) and neuropathic pain descriptor (P = .023) scores in the dexmedetomidine group were lower than those in the placebo group. CONCLUSIONS: Prophylactic intraoperative dexmedetomidine infusion reduces the incidence of chronic incisional pain as well as acute pain score after elective brain tumor resections. (Anesth Analg 2024;138:839-47) KEY POINTS• Question: Did intraoperative administration of dexmedetomidine prevent chronic incisional pain after craniotomy? • Findings: Compared with placebo, prophylactic intraoperative dexmedetomidine infusion reduced the incidence of chronic incisional pain after elective brain tumor resections. • Meaning: Our data suggest that prophylactic intraoperative dexmedetomidine may reduce chronic incisional pain after craniotomy. GLOSSARYASA = American Society of Anesthesiologists; ASD = absolute standard difference; BIS = bispectral index; CAD = coronary artery disease; CI = confidence interval; CONSORT = Consolidated Standards of Reporting Trials; Etco 2 = end-tidal carbon dioxide; IQR = interquartile range; NA = not applicable; NRS = numerical rating scale; PACU = postanesthesia care unit; RR = risk ratio; SD = standard deviation; SF-MPQ-2 = Short-Form McGill Pain Questionnaire-2; TED = tumor equivalent diameter

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Zeng,

Xu,

et al. 2023

Anesthesia &Amp; Analgesia

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“…Otherwise, delirium will be evaluated by CAM-ICU. Researchers will be routinely trained to use the above-mentioned assessments 20…”

Section: Methodsmentioning

confidence: 99%

“…Anxiety and depression will be evaluated before surgery and 5 days after surgery using Generalised Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 items (PHQ-9). The GAD-7 summed score ranges from 0 to 21, with cut-off points of 5, 10 and 15, allowing researchers to classify the anxiety as none/normal (0–4), mild (5–9), moderate (10–14) and severe 15–22. The PHQ-9 Depression Scale, a valid self-administered depression screening and diagnostic tool, was used to measure depression symptoms.…”

Section: Methodsmentioning

confidence: 99%

Dexmedetomidine after deep brain stimulation for prevention of delirium in elderly patients with Parkinson’s disease: protocol for a single-centre, randomised, double-blind, placebo-controlled trial in China

et al. 2023

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IntroductionParkinson’s disease is one of the most common neurodegenerative diseases. Deep brain stimulation (DBS) can improve motor symptoms in patients with middle and late Parkinson’s disease, reduce the use of levodopa, and thus reduce drug-related side effects. Postoperative delirium can significantly reduce the short-term and long-term quality of life in elderly patients, which can be alleviated by dexmedetomidine (DEX). However, whether prophylactic DEX could reduce the incidence of postoperative delirium in patients with Parkinson’s disease was still unknown.Methods and analysisThis is a single-centre, randomised, double-blinded, placebo-controlled group trial. A total of 292 patients aged 60 years and above elected for DBS will be stratified according to DBS procedure, subthalamic nucleus or globus pallidus interna, then randomly allocated to the DEX group or the placebo control group with a 1:1 ratio, respectively. In the DEX group, patients will be injected with the DEX continuously with an electronic pump at a rate of 0.1 µg/kg/hour for 48 hours at the beginning of general anaesthesia induction. In the control group, normal saline will be administered at the same rate for patients as in the DEX group. The primary endpoint is the incidence of postoperative delirium within 5 days after surgery. Postoperative delirium is assessed by the combination of the Richmond Anxiety Scale and the Confusion Assessment Method (CAM) for the intensive care unit or the 3-minute diagnostic interview for CAM as applicable. The secondary endpoints include the incidence of adverse events and non-delirium complications, the length of stay in the intensive care unit and hospital and all-cause 30-day mortality after the operation.Ethics and disseminationThe protocol has been approved by the Ethics Committee of Beijing Tiantan Hospital of Capital Medical University (KY2022-003-03). The results of this study will be disseminated through presentation at scientific conferences and publication in scientific journals.Trial registration numberNCT05197439.

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“…Li et al conducted a double-blind, placebo-controlled RCT to evaluate the effect of dexmedetomidine administration during intracerebral tumor resection on the incidence of postoperative delirium. 11 A total of 260 patients were randomized to either a dexmedetomidine (130 patients) or a placebo (130 patients). All patients had a standardized balanced anesthesia.…”

Section: Dexmedetomidine In the Prevention Of Delirium After Cranial ...mentioning

confidence: 99%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2023

Hayes,

Nijs,

Venkatraghavan

2024

J Neuroanaesth Crit Care

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This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from 2023 (January–November 2023). The journals reviewed include anesthesia journals, critical care medicine journals, neurosurgical journals as well as high-impact medical journals such as the Lancet, Journal of American Medical Association, New England Journal of Medicine, and Stroke. The summary of important articles will serve to update the knowledge of neuroanesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical patients.

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Dexmedetomidine administration during brain tumour resection for prevention of postoperative delirium: a randomised trial

Cited by 20 publications

References 42 publications

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial

Dexmedetomidine after deep brain stimulation for prevention of delirium in elderly patients with Parkinson’s disease: protocol for a single-centre, randomised, double-blind, placebo-controlled trial in China

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2023

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