hole-Course Application of Dexmedetomidine Combined with Ketorolac in Nonnarcotic Postoperative Analgesia for Patients with Lung Cancer Undergoing Thoracoscopic Surgery: A Randomized Control Trial

Abstract

BACKGROUND: Opioid-based postoperative analgesia provides adequate analgesia with much adverse effects and immunosuppression. Dexmedetomidine and ketorolac have properties of opioid-sparing, antiinflammation, and immune protection. OBJECTIVES: To investigate the efficacy and safety of whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia and its effect on inflammatory response and immune function in thoracoscopic surgery of lung cancer. STUDY DESIGN: Double-blind, randomized control trial. SETTING: The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China. METHODS: Sixty patients scheduled for thoracoscopic surgery were enrolled and randomly divided into 2 groups to receive a combination of intraoperative usage of dexmedetomidine and postoperative patient-controlled intravenous analgesia of dexmedetomidine 0.1 µg/kg/h and ketorolac 3 mg/kg (DEX group) or only postoperative patient-controlled intravenous analgesia of sufentanil 1.5 µg/kg and ketorolac 3 mg/kg (SUF group) for 48 hours. Vital signs, postoperative Visual Analog Scale (VAS) score, Ramsay sedation score, patient-controlled analgesia pressing times, consumption of sufentanil and rescue drug, and complications were compared between the 2 groups. The levels of inflammatory factors and immune function were also compared. RESULTS: A significant reduction in median blood pressures and heart rates within 48 hours after surgery and perioperative consumption of sufentanil were observed in the DEX group compared with the SUF group (P < 0.05). No statistically significant difference was found in VAS scores, patient-controlled analgesia pressing times, and rescue drug consumption between the 2 groups (P > 0.05). The incidence of nausea was significantly lower in the DEX group compared with the SUF group (P < 0.05). A significant decrease of interleukin (IL)-1 beta, IL-6, tumor necrosis factor (TNF)-alpha, and increased CD4+ and CD4+/CD8+ were observed in the DEX group compared with the SUF group at 24 and 48 hours after surgery (P < 0.05). There was no difference in the levels of CD8+ and natural killer cells between the 2 groups (P > 0.05). LIMITATIONS: This study was limited by its sample size. CONCLUSIONS: Whole-course application of dexmedetomidine combined with ketorolac in nonnarcotic postoperative analgesia provided adequate and safe postoperative analgesia, reduced sufentanil consumption, analgesia-related complications, alleviated inflammatory response, and immunosuppression compared with sufentanil-based analgesia in thoracoscopic surgery. KEY WORDS: Dexmedetomidine, ketorolac, sufentanil, thoracoscopic surgery, postoperative analgesic, patient-controlled analgesia, inflammatory response, immune function

A Novel Opioid-Sparing Analgesia Following Thoracoscopic Surgery: A Non-Inferiority Trial

“…Therefore, we implemented a combination of MINB and non-opioid analgesic adjuvants to achieve a potential opioid-sparing effect. Compared to the traditional intercostal block-based approach, 6 this novel opioid-sparing strategy prolonged the time to first request of analgesia, with lower PCIA pressing times and rescue analgesia, which may benefit from the opioid-sparing effect of MINB by extending 24 h after surgery.…”

“…Dexmedetomidine (DEX) and NSAIDs were recommended for postoperative analgesia to reduce opioid consumption. 4 , 5 The whole-course application of DEX combined with ketorolac 6 has been demonstrated to provide adequate and safe postoperative intravenous patient-controlled analgesia (PCIA) following thoracoscopic surgery. Based on the above, a novel opioid-sparing analgesia that combined with MINB and dexmedetomidine, as well as NSAIDs, was proposed.…”

Opioid-free anesthesia compared to opioid anesthesia for laparoscopic radical colectomy with pain threshold index monitoring: a randomized controlled study

“…Shim and colleagues reported that intraoperative intravenous dexmedetomidine and ketorolac improved postoperative analgesia after robotic-assisted laparoscopic radical prostatectomy in patients who received rectus sheath block, and significantly decreased opioid requirement during the 24 h after surgery [21]. Wen and colleagues reported that compared with sufentanil-based analgesia for thoracoscopic surgery, dexmedetomidine combined with ketorolac in non-narcotic postoperative analgesia provided adequate and safe postoperative analgesia and reduced sufentanil consumption, analgesic-related complications, inflammation, and immunosuppression [22].…”

The Role of Dexmedetomidine in Tumor-Progressive Factors in the Perioperative Period and Cancer Recurrence: A Narrative Review

“… 50 Furthermore, Guo et al found that 1 μg/kg dexmedetomidine pumped intravenously for 10 min as a loading dose and maintained at 0.4 μg/(kg·h) until 30 min before the end of lung cancer operation reduced the TNF-α level of patients, 51 which was also reported by other studies with different dexmedetomidine infusion rates. 52 Moreover, dexmedetomidine infusion could also promote CD3+ and CD4+ levels and CD4+/CD8+ ratio and decrease IL-6 levels in lung cancer operation 6 , 53–56 compared with the control. Patients pumped with 0.5 μg/kg dexmedetomidine intravenously for 15 min as a loading dose and maintained at 0.4 μg/(kg·h) until the end of oral cancer operation had elevated CD3+ and CD4+ levels and CD4+/CD8+ ratio.…”