Dexmedetomidine Reduces Perioperative Opioid Consumption and Postoperative Pain Intensity in Neurosurgery: A Meta-analysis

Liu, Yi; Feng, Lixia; Liu, Xiaochen; Shao, Xinxin; Jiang, Nan; Gan, Xiaoliang

doi:10.1097/ana.0000000000000403

Cited by 61 publications

(53 citation statements)

References 22 publications

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“…However, the mechanism of action of dexmedetomidine on the control of intracranial pressure has not been clarified fully. Several factors may be involved, such as PaCO 2 , PaO 2 , temperature, pH, cerebral metabolic rate, and blood viscosity (Liu et al, ; Wenjie, Houqing, & Gengyun, ). Dexmedetomidine can decrease cerebral perfusion pressure, cerebral metabolic rate equivalent/cerebral blood flow ratio and increase cerebrovascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Ren

et al. 2019

Brain and Behavior

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Background Rapid emergence from general anesthesia during endovascular interventional therapies (EITs) is important. However, the solution that improved quality of both analepsia and postoperative recovery after EITs has not been specifically addressed. We conducted this prospective, randomized, controlled trial to evaluate the intraoperative infusion of dexmedetomidine on quality of analepsia and postoperative recovery in patients undergoing EITs. Methods Eighty‐six patients undergoing EITs were divided into three groups: RD1 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.2 μg kg−1 hr−1 throughout EIT), RD2 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.4 μg kg−1 hr−1 throughout EIT), and RD3 (dexmedetomidine at an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT). An analgesia system delivered sufentanil only. The primary outcome measure was the total consumption of nimodipine during the first 48 hr after surgery. The secondary outcome measures were sufentanil consumption, pain intensity, hemodynamics, functional activity score (FAS), neurologic examination, level of sedation (LOS), and Bruggrmann comfort scale (BCS). We also recorded the intraoperative hemodynamic data, requirement of narcotic and vasoactive drugs, prevalence of complications and symptomatic cerebral vasospasm, duration of postanesthesia care unit (PACU) stay, Glasgow Outcome Score (GOS) at 3 months, and prevalence of cerebral infarction 30 days after surgery. Results Dexmedetomidine application in the regimen RD3 reduced the consumption of the total dose of nimodipine and sufentanil 48 hr after surgery, prevalence of symptomatic cerebral vasospasm, consumption of narcotic drugs and nimodipine during surgery, pain intensity during the first 8 hr after surgery, and increased both BCS during the first 4 hr after surgery and hemodynamic stability. However, the LOS was increased at the 0.5 hr after surgery and surgeon satisfaction score was lower. There were no significant differences among the groups for consumption of vasoactive drugs except urapidil, Glasgow coma scale (GCS) and FAS during the first 48 hr after surgery, GOS at 3 months, and cerebral infarction after 30 days. Conclusions Dexmedetomidine (an initial dose of 0.5 μg/kg for 10 min adjusted to 0.6 μg kg−1 hr−1 throughout EIT) could reduce the total consumption of nimodipine and opioid during the first 48 hr after surgery, the concerning adverse effects, and improve pain scores. The optimal dosage of dexmedetomidine during EITs merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Ren

et al. 2019

Brain and Behavior

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“…68 Intraoperative administration of DEX could reduce perioperative and PACU opioid consumption as well as postoperative pain intensity in the PACU after neurosurgery. 69 IV DEX was proved effective for preventing emergence agitation and reducing severe pain and the requirement of rescue drugs in the PACU in children. 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.…”

Section: Pharmacological Managementmentioning

confidence: 99%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

103

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Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

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“…Interestingly, the extubation time was noted to be 5.46 minutes shorter in the group receiving DEX. 1 Overall, this meta-analysis shows that DEX can be utilized as an opioid sparing analgesic in neurosurgical cases. Opioid-free to minimal opioid regimens offer less opioid-related side-effects and may provide better neurological examination conditions with fewer negative cognitive effects.…”

Section: Dexmedetomidine and Pain In Neurosurgerymentioning

confidence: 79%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2018

Rogan

Chowdhury

Venkatraghavan

2019

Journal of Neuroanaesthesiology and Critical Care

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Dexmedetomidine Reduces Perioperative Opioid Consumption and Postoperative Pain Intensity in Neurosurgery: A Meta-analysis

Abstract: DEX could reduce perioperative and PACU opioid consumption as well as postoperative pain intensity.

Cited by 61 publications

References 22 publications

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Effect of intraoperative infusion of dexmedetomidine on postoperative recovery in patients undergoing endovascular interventional therapies: A prospective, randomized, controlled trial

Postoperative pain management in the postanesthesia care unit: an update

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2018

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