Effect of intraoperative dexmedetomidine on postoperative pain and pulmonary function following video-assisted thoracoscopic surgery

Abstract

Context: Acute postoperative pain following video-assisted thoracoscopic surgery (VATS) needs considerable attention, if untreated leads to chronic pain and postoperative lung dysfunction. Dexmedetomidine, α 2 adrenoceptor agonist has shown promising results of opioid-sparing effects. Aims: The objectives of this study are to investigate the effect of dexmedetomidine on postoperative analgesia and pulmonary mechanics in patients undergoing VATS. Settings and Design: This is a randomized controlled trial. Subjects and Methods: We conducted a prospective, randomized, double-blind study on lung cancer patients undergoing VATS. Each patient received either dexmedetomidine or comparable volume of normal saline during the intraoperative period. In the recovery unit, postoperative visual analog scale (VAS) score, rescue analgesic requirements, arterial blood gas values, and pulmonary function tests were recorded. Statistical Analysis Used: Data are analyzed using unpaired t-test , Mann–Whitney U-test, and Fischer's exact test. P < 0.05 was considered statistically significant. Results: VAS scores were significantly lower ( P < 0.05) in the dexmedetomidine group at rest, on coughing and on mobilization from supine to sitting position. The partial pressure of arterial oxygen measured in postanesthesia care unit was significantly higher in the dexmedetomidine group (88 ± 8.2 vs 78 ± 9.1 mmHg). Forced expiratory volume in 1 was significantly greater in the dexmedetomidine group compared to the control group on the first 2 postoperative days ( P < 0.05). The length of hospital stay was significantly reduced by dexmedetomidine. Conclusions: Intraoperative dexmedetomidine administration improves the quality of analgesia and postoperative lung function in patients undergoing VATS.

PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations

“…Jannu et al. [ 13 ] also compared two groups of patients receiving either i.v. dexmedetomidine or saline.…”

“…We recommend intra‐operative use of i.v. dexmedetomidine because two studies documented that it reduces pain scores and opioid demand [ 12 , 13 ]. Dexmedetomidine also decreased the incidence of postoperative agitation and cognitive dysfunction, and postoperative nausea and vomiting [ 12 , 13 , 14 ].…”

“…dexmedetomidine because two studies documented that it reduces pain scores and opioid demand [ 12 , 13 ]. Dexmedetomidine also decreased the incidence of postoperative agitation and cognitive dysfunction, and postoperative nausea and vomiting [ 12 , 13 , 14 ]. An improvement in lung function with an increase in FEV1 and vital capacity has also been demonstrated [ 12 , 13 ].…”

“…Dexmedetomidine also decreased the incidence of postoperative agitation and cognitive dysfunction, and postoperative nausea and vomiting [ 12 , 13 , 14 ]. An improvement in lung function with an increase in FEV1 and vital capacity has also been demonstrated [ 12 , 13 ]. Dexmedetomidine, which is an α2‐adrenergic agonist, may cause bradycardia and hypotension.…”

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

“…106 In patients undergoing VATS, evidence has shown that intraoperative dexmedetomidine can reduce postoperative pain, patient satisfaction, and improve pulmonary mechanics. 107,108 Data regarding the benefit of postoperative administration are unclear because of mixed results and heterogenous administration regimens between studies. 109,110 In open cardiac surgery, studies using dexmedetomidine have demonstrated less postoperative delirium, 111 kidney injury, 112 and death.…”