Effect of Intraoperative Sedation with Dexmedetomidine Versus Propofol on Acute Postoperative Pain Following Major Foot Surgery under Popliteal Sciatic Nerve Block: A Randomized Controlled Trial

Abstract

Intravenous (IV) dexmedetomidine is reported to prolong analgesia following peripheral nerve blocks. Popliteal sciatic nerve block provides effective postoperative analgesia, but some patients still experience severe pain during the early postoperative period. We aimed to evaluate the postoperative analgesic effects of IV dexmedetomidine versus propofol in patients undergoing foot surgeries under popliteal sciatic nerve block. Forty patients were enrolled and randomly assigned to receive either IV propofol (n = 20) or IV dexmedetomidine (n = 20) for intraoperative sedation. All the patients received continuous popliteal sciatic nerve block. The corresponding drug infusion rate was adjusted to achieve a modified observer’s assessment of alertness/sedation score of 3 or 4. The primary outcome was postoperative cumulative opioid consumption during the first 24 h after surgery. Thirty-nine patients were analyzed. The median (interquartile ranges) postoperative cumulative opioid consumption during the first 24 h after surgery was significantly lower in the dexmedetomidine group (15 (7.5–16.9) mg) than in the propofol group (17.5 (15–25) mg) (p = 0.019). The time to first rescue analgesic request was significantly greater in the dexmedetomidine group than in the propofol group (11.8 ± 2.2 h vs. 10.0 ± 2.7 h, p = 0.030) without the prolonged motor blockade (p = 0.321). Intraoperative sedation with dexmedetomidine reduced postoperative opioid consumption and prolonged analgesic duration after a popliteal sciatic nerve block.

Perioperative Hypotension in Patients Undergoing Orthopedic Upper Extremity Surgery with Dexmedetomidine Sedation: A Retrospective Study

“…Dexmedetomidine is a commonly chosen sedative agent for orthopedic procedures not only due to its favorable respiratory profile but also for its ability to extend the duration of spinal or peripheral nerve blocks and reduce postoperative opioid consumption [7,8,[21][22][23]. This favorable effect may be dose-dependent, especially in the case of peripheral blockades.…”

“…Dexmedetomidine is also commonly used for patients undergoing orthopedic surgery with regional anesthesia. Thanks to its ability to prolong the analgesic effect of regional 2 of 11 blockade and reduce postoperative opioid consumption, dexmedetomidine is considered a valuable sedative agent following peripheral nerve blockade [7,8]. Although these benefits of dexmedetomidine have been widely recognized, its potential negative impact on hemodynamics, particularly in the context of intraoperative sedation for patients receiving peripheral nerve blocks, has gained less research attention.…”