Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic

Tang, Chaoliang; Xia, Zhongyuan

doi:10.2147/jpr.s139387

Cited by 106 publications

(75 citation statements)

References 46 publications

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“…Moreover, Dex has been proved to alleviate NPP by modulating the Janus kinase (JAK)–signal transducer and activator of transcription (STAT) pathway in rats (Xun & Zheng, 2020), indicating its association with sensory abnormalities. A wide spectrum of clinical studies have demonstrated that intraoperative Dex significantly reduced postoperative pain intensity and the need for opioid application, and the incidence of opioid‐associated adverse events (Schnabel, Meyer‐Friessem, Reichl, Zahn, & Pogatzki‐Zahn, 2013; Tang & Xia, 2017).…”

Section: Introductionmentioning

confidence: 99%

Analgesic effect of dexmedetomidine in rats after chronic constriction injury by mediating microRNA‐101 expression and the E2F2–TLR4–NF‐κB axis

Zhang

Cui

et al. 2020

Experimental Physiology

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New Findings What is the central question of this study?Dexmedetomidine has a capacity for sedation, anti‐anxiety and analgesia with minimal suppression of respiratory function; what is its role in neuropathic pain and what is the involvement of miRNAs? What is the main finding and its importance?Dexmedetomidine attenuates inflammation and apoptosis and the stimulation of TLR4–NF‐κB signalling in rat spinal cord via miR‐101 overexpression and E2F2 downregulation. Abstract The significant analgesic effect of dexmedetomidine (Dex) has been underscored in neuropathic pain (NPP), but the underlying mechanism remains unclear. This study explored the functional effect of Dex on microRNA (miR)‐101‐regulated E2 promoter binding factor 2 (E2F2) with the engagement of Toll‐like receptor 4 (TLR4)–nuclear factor‐κB (NF‐κB) signalling. Chronic constriction injury (CCI) was performed to generate an NPP rat model. The expression of miR‐101, E2F2 and TLR4–NF‐κB signalling‐relevant proteins was assessed by RT–quantitative PCR, immunoblotting and immunohistochemistry. Inflammatory factors were detected by enzyme‐linked immunosorbent assay. The results showed that Dex increased mechanical withdrawal threshold and thermal latency to withdraw. The expression of interleukin (IL)‐6, IL‐8 and tumour necrosis factor‐α was increased in CCI rats, but these trends were reversed by Dex. In addition, Dex repressed caspase‐9 expression and apoptotic cell numbers in spinal cord tissues in CCI rats. Moreover, the expression of E2F2 was significantly increased, while miR‐101 was diminished in CCI rats, which was reversed by Dex. Furthermore, miR‐101 inhibitor, E2F2 restoration or administration of a TLR4‐specific agonist weakened the effect of Dex. Together, these results suggest that Dex has the capacity to ameliorate NPP by regulating the miR‐101–E2F2–TLR4–NF‐κB axis in rats subjected to CCI.

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Section: Introductionmentioning

confidence: 99%

Analgesic effect of dexmedetomidine in rats after chronic constriction injury by mediating microRNA‐101 expression and the E2F2–TLR4–NF‐κB axis

Zhang

Cui

et al. 2020

Experimental Physiology

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“…Different pathways between the sedation and analgesic effects of dexmedetomidine could explain it perhaps (16). The effect of dexmedetomidine is mediated by the ascending noradrenergic pathway in the locus coeruleus, while the analgesic effect occurs via an a2-adrenergic receptor-dependent descending pathway in the spinal cord (20). Animal studies have shown that the addition of dexmedetomidine to local anesthetic would increase the duration of sensory and motor blockade in a rat model of sciatic nerve blockade (21).…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

Pan

Liu

et al. 2020

Preprint

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Background: Dexmedetomidine showed some potential in pain control in patients undergoing Total Knee Arthroplasty (TKA). Nerve block is a preferable alternative for postoperative analgesia after TKA, on which dexmedetomidine had an effect controversially. This study aimed to meta-analyze the available randomized controlled trials to determine the efficacy and safety of dexmedetomidine as an adjunct to local anesthetics in nerve block after TKA. Methods: PubMed, Embase, Cochrane Library, Web of science and ScienceDirect databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to February 1 st , 2020 . The primary outcomes included pain scores, duration of analgesia, total opioids consumption in 24 hours postoperatively, and patient satisfaction. The second outcomes were motor strength, sedation degree and postoperative nausea and vomiting, and other related complications. The methodological quality was assessed by the Cochrane risk of bias tool. Results: The initial search yielded 143 studies, of which 7 met the inclusion criteria finally. The pooled data indicated that dexmedetomidine combined with local anesthetics in nerve block in TKA could decrease postoperative pain scores at rest (SMD=-1.01[95%CI, -1.29 to -0.72], p<0.01) and at motion(SMD=-1.01[-1.25 to -0.77], p<0.01,), decrease the total opioids consumption within 24 hours(SMD=-0.63[-0.86 to -0.40], p<0.01), prolong the analgesia duration(SMD=0.90[0.64 to 1.17], p<0.01), improve motor strength(SMD=0.23[0.01 to 0.45], p=0.04) and the sedation degree (SMD=0.94[0.70 to 1.18], p<0.01), and increase the patient satisfaction(SMD=0.88[0.60 to 1.17], p<0.01) without adding nausea and vomiting(RD=-0.05[-0.11 to 0.01],p=0.14), and other related complications(RD=-0.01[-0.08 to 0.07],p=0.89), compared with local anesthetics alone in nerve block. Conclusions: It was effective and safe for dexmedetomidine as an adjunct to local anesthetics in nerve block in TKA to relieve postoperative pain, decrease total opioids consumption, prolong analgesic duration and increase patient satisfaction without increasing related complications. Based on the quality evidence we got, we recommended dexmedetomidine as a regular regimen in nerve block for patients undergoing TKA. Registration: This meta-analysis was prospectively registered on PROSPERO (International prospective register of systematic reviews) and the registering number was CRD42020169171.

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“…A escolha cuidadosa e individualizada do protocolo anestésico deve ser sempre prioridade, sobretudo para mamíferos exóticos, cujas particularidades fisiológicas requerem práticas pormenorizadas de contenção em detrimento dos riscos para o paciente e para a equipe [1]. A dexmedetomidina é um sedativo alfa-2 agonista que foi eleito em razão da elevada seletividade; ação relaxante muscular; possibilidade de administração por vias alternativas à intravenosa; menor interferência na função respiratória em relação a outros medicamentos da classe; oferta analgésica adicional, além de possuir antagonista específico [7,13].…”

Section: Discussionunclassified

Nerve Stimulator-Guided Ciatic and Femoral Nerve Block during Tibial Osteosynthesis in Chinchilla lanigera

Lemos

Vieira

Gusmão

et al. 2019

Acta Scientiae. Vet.

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Background: Nociceptive stimulation in orthopedic surgery requires effective pain management to ensure trans and postoperative patient comfort. Several techniques can be used for this, and multimodal analgesia protocols such as guided locoregional blocks provide a balanced effect, as they enable the use of low-dose anesthetics and offer rapid recovery. The benefits of specific nerve blocks in domestic animals are well known; however, there are few reports that have ascertained their safety in wild species. This report is aimed at describing the successful use of neurolocalizer-guided sciatic and femoral nerve blocks during tibial osteosyntheses in a chinchilla. Case: A 9-month-old chinchilla weighing 0.56 kg was referred for surgery for proximal and mid-diaphyseal tibia fractures resulting from trauma. Following preanesthetic evaluation, the animal received intramuscular dexmedetomidine (15 µg kg -1) as preanesthetic medication. Sedation was apparent after 15 min and was verified by a decreased activity, the animal allowing manipulation, absence of the eyelid and righting reflexes, and limb movement after clamping removal of limb after clamping. After achieving sedation, anesthesia was induced and maintained with sevoflurane (FiO2 = 1.0), supplied through a nasoral mask. Sciatic and femoral nerve blocks were performed with the aid of a neurostimulator. A needle was inserted into the femoral triangle, cranial to the femoral artery, and into the depression between the sciatic tuberosity and the greater femoral trochanter. The neurostimulator was set at a pulse frequency of 1 Hz, pulse duration of 0.1 ms and initial current of 0.6 mA. The needle was advanced toward the nerves until muscle contractions were observed, and the current was gradually reduced until contractions were manifested at a minimum current of 0.2 mA. Ropivacaine 0.2% (1 mg kg -1) was injected at each point. Intraoperative physiological parameters remained stable and within the reference limits while the animal was under light anesthesia. Signs of recovery appeared soon after the inhaled anesthesia was stopped; awakening was gradual and without any signs of excitement or other adverse effects, eliminating the need for additional analgesic medication. Subcutaneous fluid therapy, antibiotics, and anti-inflammatory medications were administered immediately postoperatively. Discussion: This report is groundbreaking in describing neurostimulation-guided sciatic and femoral nerve blocks as an alternative to epidural anesthesia for hind limb surgery; furthermore, it demonstrates the efficacy and safety of ropivacaine in Chinchilla lanigera, which is relevant to the clinical use of the drug as part of a rodent anesthetic protocol. Sevoflurane associated dexmedetomidine use and locoregional anesthesia resulted in cardiorespiratory stability and the absence of behavioral signs of pain in the immediate postoperative period. The technique was easy to apply, and the use of the neurolocalizer increased blockade safety by allowing anesthesia administration as clo...

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Dexmedetomidine in perioperative acute pain management: a non-opioid adjuvant analgesic

Cited by 106 publications

References 46 publications

Analgesic effect of dexmedetomidine in rats after chronic constriction injury by mediating microRNA‐101 expression and the E2F2–TLR4–NF‐κB axis

Analgesic effect of dexmedetomidine in rats after chronic constriction injury by mediating microRNA‐101 expression and the E2F2–TLR4–NF‐κB axis

Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

Nerve Stimulator-Guided Ciatic and Femoral Nerve Block during Tibial Osteosynthesis in Chinchilla lanigera

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