Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study

Abstract

BackgroundAmbulatory surgery has recently gain popularity, as it is a good method of optimizinghospital resources utilization. To support ambulatory surgery, anaesthetic goals nowrevolve around patients’ early recovery with minimal pain and nausea, expedientdischarge home and prompt resumption of activities of daily living. In this study, weevaluated the effect of a single pre-induction dose of dexmedetomidine on anaestheticrequirements, postoperative pain and clinical recovery after ambulatory ureteroscopy andureteric stenting under general anaesthesia.MethodsSixty patients were randomised to receive IV dexmedetomidine 0.5 μg.kg-1 (Group DEX, n = 30) or IV saline (Group P, n = 30). General anaesthesia was maintained with Sevoflurane: oxygen: air, titrated to BIS 40–60. Pain intensity, sedation, rescue analgesics, nausea/vomiting and resumption of daily activities were recorded at 1 h, and postoperative day (POD) 1–5.ResultsGroup DEX patients had significant reduction in sevoflurane minimum alveolar concentration (MAC), mean (SD) DEX vs. Placebo 0.6 (0.2) vs. 0.9 (0.1), p = 0.037; reduced postoperative resting pain at 1 h (VAS 0–10) (mean (SD) 1.00 (1.84) vs. 2.63 (2.78), p = 0.004), POD 1 (mean (SD) 1.50 (1.48) vs. 2.87 (2.72), p = 0.002), POD 2 (0.53 (0.97) vs. 1.73 (1.96), p = 0.001) and POD 3 (0.30 (0.75) vs. 0.89 (1.49), p = 0.001). DEX patients also had less pain on movement POD 1 (3.00 (2.12) vs. 4.30 (3.10), p = 0.043) and POD 2 (2.10 (1.98) vs. 3.10 (2.46), p = 0.040), with higher resumption of daily activities by 48 h compared to placebo, 87% vs. 63%, p = 0.04.ConclusionsWe conclude that a single dose of dexmedetomidine was a useful adjuvant in reducing MAC and postoperative pain (at 1 h and POD 1–3), facilitating faster return to daily activities by 48 h.Trial registrationThe Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001120369, 31st July 2017, retrospectively registered.

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

“…Meanwhile, Shariffudin et al found a significant decrease in the systolic blood pressure at the 15-min mark after infusion. This phenomena disappeared by the 20-min mark and did not return for the remainder of the case [69]. It appears that these episodes of hemodynamic disturbance are associated with the use of a loading dose or fast initial infusion rates.…”

“…They reported a reduction of the MAC of sevoflurane (0.6 (0.2) vs. 0.9 (0.1), p = [10,44] 0 . 1 5 -4 mcg/kg 0.2-0.7 mcg/kg/h IV PCA (with opioid) [53,54] 2.5-10 mcg or 0.1 mcg/kg 0.02-0.6 mcg/kg/h basal rate or 2.5-10 mcg/h 10-15-min lockout IV PCA (as sole agent) [9••] 0.25 mcg 0.5 mcg/kg/h 15-min lockout Oral [57] 4 m c g / k g Intranasal [45,58] 1 -2 mcg/kg Buccal [59] 2.5 mcg/kg Intramuscular [59] 2.5 mcg/kg IV, intravenous; PCA, patient-controlled analgesia; min, minute 0.037) needed to achieve adequate sedation, as well as a 60% reduction of pain immediately postop with further reduction lasting until POD 3 [69]. Panchgar et al had similar results in laparoscopic surgeries with a loading dose of 1 μg/kg body weight and then a maintenance dose of 0.5 μg/kg/h for the remainder of the procedure.…”

“…The major side effect noted in many of these studies was hemodynamic instability in the form of bradycardia and hypotension [69,70,74]. These changes, although statistically significant, were well tolerated by most of study participants.…”

“…These changes, although statistically significant, were well tolerated by most of study participants. Some studies suggest that this is beneficial in that it curtails hemodynamic stress response generated by the trauma of surgery [69]. Still other studies did not find dexmedetomidine to be superior to other drugs.…”

Effect of preoperative administration of systemic alpha-2 agonists on postoperative pain: a systematic review and meta-analysis

“…Nevertheless, controversy exists regarding whether preoperative use of alpha-2 agonists as sedatives has an effect on reducing postoperative pain. Shariffuddin et al [ 5 ] concluded that a single dose of dexmedetomidine was a useful adjuvant in reducing postoperative pain, and Sung et al [ 6 ] demonstrated that oral clonidine premedication reduced the requirement of postoperative analgesia in patients undergoing laparoscopic cholecystectomy. However, Lee et al [ 7 ] found that pre-anesthetic administration of a single loading dose of dexmedetomidine given 10 min before induction did not reduce patient-controlled anesthesia consumption of postoperative fentanyl or the pain score.…”