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

Abstract

Burn-induced acute post-operative pain and the associated stress response may result in prolonged convalescence. The present study investigated the effects of dexmedetomidine (DEX) administration on post-operative pain and the quality of recovery following surgical treatment of moderate-to-severe burn injuries. A total of 60 adult patients undergoing tangential excision skin grafting were randomized into two groups. The DEX group (Group D) received an intravenous (i.v.) single-dose bolus injection of DEX 0.5 µg/kg >10 min prior to induction of anesthesia. Patient-controlled intravenous analgesia (PCIA) was provided to the patients from the end of the surgery, which consisted of 100 µg sufentanil plus 200 µg DEX. The control group (Group C) received an equal volume of normal saline as a pre-operative bolus and post-operative PCIA of 100 µg sufentanil infusion. The Visual Analogue Scale (VAS) score at rest and during movement, the cumulative dose of sufentanil and the 40-item quality of recovery questionnaire (QoR-40) score were assessed at various time-points after the surgery. During the first 24 h post-surgery, patients in Group D exhibited a lower VAS score at rest and during movement, a lower number of PCIA pump presses (29.17±1.91 vs. 34.13±2.73) and lower sufentanil consumption (62.58±0.96 vs. 65.27±1.26) compared with those in Group C (P<0.05). Furthermore, the QoR-40 recovery score of patients in Group D at 24 h post-surgery was higher compared with that in Group C (P<0.01). In conclusion, the present study indicated that a pre-operative bolus of DEX (0.5 µg/kg) followed by DEX plus sufentanil by PCIA subsequent to surgery improved the quality of analgesia and promoted the quality of recovery at 24 h following tangential excision skin grafting treatment of patients with moderate-to-severe burn injuries compared to PCIA of 100 µg sufentanil only. The present study was retrospectively registered with the trial registration no. ChiCTR1800016646 (date of registration, 14/06/2018).

Efficacy of dexmedetomidine versus midazolam when combined with butorphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial

“…Dexmedetomidine has gained popularity in various kinds of diseases ( Su et al, 2016 ), but its clinical use in burn treatment is still limited. Jiang et al (2019) reported that it can be successfully used for perioperative sedation in burn patients. Asmussen et al (2013) found the beneficial effects of dexmedetomidine in burn patients.…”

The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis

“…There were 33 RCTs with 2676 patients included in this review, and the PRISMA flow diagram 41 is displayed in Figure 1. 42–74 All but 8 RCTs 43,49,50,52,54,64,65,74 included at least 1 secondary outcome. Seven studies 46,55,57,62,68,69,71 premedicated their patients with benzodiazepines.…”

“…PACU LOS was reported as the time to reaching a prespecified Aldrete score in 16 studies: ≥8 and 9 in 11 studies, 45,47,48,[54][55][56]60,63,68,70,72 >9 in 4 studies, [64][65][66]69 and as per institute's criteria in 1 study. 42 One study 61 relied on anesthetist judgment, and 3 studies 44,52,53 cited local criteria to determine discharge from the PACU.…”

Sedation With Dexmedetomidine in Critically Ill Burn Patients Reduced Delirium During Weaning From Mechanical Ventilation

“…Dexmedetomidine is considered a reliable treatment option for the prevention and treatment of delirium in ICU patients which could facilitate faster weaning from mechanical ventilation when compared with conventional sedation agents [6,7]. A number of publications support the advantageous profile for sedation and analgesia in intubated and mechanically ventilated burn patients during treatment in the intensive care unit and sedation prior to and/or during burns debridement and dressings or other procedures on nonintubated burn patients [8][9][10][11][12][13][14]. Dexmedetomidine has an acceptable tolerability profile; with hypotension, hypertension, and bradycardia being the most commonly reported adverse reactions [15].…”