Effect of dexmedetomidine infusion for intravenous patient-controlled analgesia on the quality of recovery after laparotomy surgery

Abstract

BackgroundThe Quality of Recovery-15 (QoR-15) is a patient-centered questionnaire to evaluate the recovery after surgery and anesthesia. Dexmedetomidine has sedative, analgesic, antiinflammatory and inhibitory sympathetic effects, which may contribute to early recovery. We hypothesized dexmedetomidine added to intravenous patient-controlled analgesia (PCA) could enhance the quality of recovery (QoR) in patients undergoing laparotomy surgery.MethodsIn this randomized, double-blind, controlled study, 100 patients undergoing laparotomy surgery were randomly allocated into two groups: Dexmedetomidine (group D) and control (group S). Patients in the group D (n = 46) received dexmedetomidine 0.04 ug/(kg·h) plus sufentanil 0.02 ug/(kg·h) for 48 h after laparotomy surgery, and in the group S (n = 47) received sufentanil 0.04 ug/(kg·h) only. The QoR-15 scores, postoperative pain, rescue analgesia, recovery of gastrointestinal function, patient satisfaction and adverse effects were recorded.ResultsThe QoR-15 scores were significantly higher in the group D than in the group S on postoperative day (POD) 1, 2, 3 and 5 (P < 0.05). The visual analog scale (VAS) scores were significantly lower in the group D compared with group S within 48 h after surgery (P < 0.05). The pressing times of analgesic pump and rescue tramadol were not significantly different between the two groups (P > 0.05). The incidence of nausea was significantly lower in the Group D. No hypotension, bradycardia, or respiratory depression was observed.ConclusionsThe addition of dexmedetomidine to PCA enhanced patient-centered recovery, reduced pain and adverse effect, and improved patient satisfaction after laparotomy surgery.

The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for Postoperative Analgesia in Elderly Patients With Postoperative Delirium and Early Postoperative Cognitive Dysfunction: A Single-Center, Prospective, Randomized, Double-Blind, Controlled Trial

“…Furthermore, nocturnal administration of low-dose DEX in critically ill patients reduced the incidence and duration of delirium (Skrobik et al, 2018). DEX used for patient-controlled analgesia (PCA) reduced pain and adverse effects and improved patient satisfaction after surgery (Xin et al, 2017). However, few studies have evaluated the efficiency of DEX used for PCA against POD and early POCD.…”

Efficacy of dexmedetomidine in reducing post‑operative pain and improving the quality of recovery in patients with burn wounds undergoing tangential excision skin grafting

“…However, there was no significant difference between Groups C and D with regard to the supplemental requirement for tramadol. Of note, the analgesic and opioid dose-reducing/sparing effects of DEX have been well documented in previous studies in adult and pediatric patients (7,8,27). Together with these results, the present study demonstrated that pre-operative administration of 0.5 µg/kg DEX and the administration of DEX in combination with sufentanil PCIA provided effective analgesia following tangential excision skin grafting.…”

“…Furthermore, similar results were obtained in a previous study for thoracic surgery where an infusion dose of 0.04 µg/kg/h DEX in combination with 0.02 µg/kg/h sufentanil reduced post-operative pain during the initial 72 h post-surgery (26). In the present study, DEX was administered at an infusion dose of ~0.03 µg/kg/h DEX, which is an approach that has been used for patient-controlled analgesia in Asian patients (7). The present results indicated that the combined use of DEX with sufentanil had an improved capacity to relieve post-operative acute pain at rest and during movement compared with sufentanil alone.…”

“…A recent study indicated that in patients undergoing cervical spine surgery, the intra-operative and post-operative use of DEX was able to reduce the post-operative requirement of analgesics and promote recovery (6). Multiple studies have indicated that DEX has an active influence on recovery (7–9), even at a single dose (10). However, few studies have assessed the effects of DEX on analgesia and general anesthesia recovery in patients with burns.…”

Dexmedetomidine reduces inflammation in traumatic brain injury by regulating the inflammatory responses of macrophages and splenocytes

“…In vitro studies have demonstrated that dexmedetomidine significantly reduced lipopolysaccharide (LPS)-induced secretion of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 (13). In clinical practice, studies have illustrated similar anti-inflammatory effects although inconsistencies between studies exist (13)(14)(15)(16)(17)(18). Dexmedetomidine also reduces patients' need for anesthetic treatment (19), and can reduce the blood pressure and heart rate of patients in a dose-dependent manner (20).…”