Intranasal Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Total Knee Arthroplasty Under General Anesthesia

Seppänen, Suvi-Maria; Kuuskoski, Ronja; Mäkelä, Keijo; Saari, Teijo I.; Uusalo, Panu

doi:10.1016/j.arth.2020.09.032

Cited by 10 publications

(7 citation statements)

References 30 publications

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“…Two patients required one to two single doses of ephedrine for hypotension, which suggests that careful observation of hemodynamics for at least 3 h after administration of intranasal dexmedetomidine in geriatric patients is warranted. Weight-adjusted mean dexmedetomidine dose in our study was 1.31 µg/kg, which is similar to intranasal dexmedetomidine dosages used in previous adult studies [7,21]. Perhaps an even smaller amount of dexmedetomidine might suffice for older adults, which in turn would probably result in even less hemodynamic side effects.…”

Section: Discussionsupporting

confidence: 80%

“…When contemplating postoperative analgesic regimens for geriatric patients, caregivers must balance efficacy with the incidence of interactions and adverse effects of medications [34]. Analgesic effect of dexmedetomidine is well established and prior studies suggest that dexmedetomidine in the intranasal form has an opioid-sparing effect [7,35]. As with prior studies, nasal dexmedetomidine reduced opioid consumption considerably in our study.…”

Section: Discussionsupporting

confidence: 75%

“…Postoperative intravenous dexmedetomidine has been suggested to reduce the risk of delirium in surgical patients, particularly following cardiac surgery, whereas no such data are available on intranasal administration [5]. Perioperatively administered intranasal dexmedetomidine has mostly been studied in pediatric populations, and data on adult patients are scarce [6,7]. Intranasal dexmedetomidine exerts high bioavailability in healthy volunteers [8] but use of this administration route has not been previously studied in a postoperative setting in adult patients.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

2021

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Objective The aim of this study was to report preliminary data on the use of intranasal dexmedetomidine to treat postoperative restlessness, agitation, and pain in 23 patients aged > 70 years and undergoing orthopedic surgery. Background Postoperative agitation and delirium are common among older adult patients undergoing orthopedic surgery. Most preparations used to treat agitation and delirium carry a risk for adverse events such as respiratory failure. Moreover, mere opioid therapy may be insufficient in treatment of pain. Dexmedetomidine, an α2-adrenoreceptor agonist with sedative and analgesic properties, has been shown to reduce opioid requirement and reduce postoperative delirium in older adults. Methods We studied the use of post-operative intranasal dexmedetomidine in a retrospective study cohort of geriatric patients undergoing orthopedic surgery. Primary outcomes included alterations in heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2), Modified Richmond Agitation and Sedation Score (mRASS), and opioid consumption following dexmedetomidine administration. Results We identified 23 patients with a mean (SD) age of 79.9 (7.5) years who received dexmedetomidine 100 µg intranasally postoperatively. After dexmedetomidine administration, HR decreased by 10.4 (3.7) beats/min (95% CI 2.9-17.8; p = 0.004) and MAP by 16.2 (4.4) mmHg (95% CI 7.3-25.1; p < 0.001). HR decrease was significant at 2 h and MAP decrease at 1, 2, and 3 h following dexmedetomidine administration. Dexmedetomidine administration was associated with significant reductions in opioid consumption (p < 0.001) and mRASS score (p < 0.001). SpO 2 and RR remained unchanged. Conclusions These preliminary findings suggest that intranasal dexmedetomidine reduces opioid consumption without causing respiratory depression and may be used to treat postoperative restlessness, agitation, and pain in geriatric patients. However, hemodynamic effects of dexmedetomidine may require close observation for 3 hours following administration in older adult patients.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

2021

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“…Future directions for intranasal pain management include identifying and investigating potential drug candidates, improving delivery strategies and optimizing central nervous target concentrations. Drug candidates for (co-)analgesia using an intranasal administration route under investigation include NK1-receptor antagonists [ 92 ], ketamine [ 93 ] and esketamine [ 94 ], nalbuphine [ 95 ], ketorolac [ 96 ], dexmedetomidine [ 97 ] and many more. There is also a wide variety of research on permeation-enhancing agents, mucolytic agents, muco-adhesive agents, in situ gelling agents and enzyme-inhibiting agents in the formulation of nasal drug delivery systems [ 98 ].…”

Section: Future Directionsmentioning

confidence: 99%

Intranasal Administration for Pain: Oxytocin and Other Polypeptides

et al. 2021

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Pain, particularly chronic pain, remains one of the most debilitating and difficult-to-treat conditions in medicine. Chronic pain is difficult to treat, in part because it is associated with plastic changes in the peripheral and central nervous systems. Polypeptides are linear organic polymers that are highly selective molecules for neurotransmitter and other nervous system receptors sites, including those associated with pain and analgesia, and so have tremendous potential in pain therapeutics. However, delivery of polypeptides to the nervous system is largely limited due to rapid degradation within the peripheral circulation as well as the blood–brain barrier. One strategy that has been shown to be successful in nervous system deposition of polypeptides is intranasal (IN) delivery. In this narrative review, we discuss the delivery of polypeptides to the peripheral and central nervous systems following IN administration. We briefly discuss the mechanism of delivery via the nasal–cerebral pathway. We review recent studies that demonstrate that polypeptides such as oxytocin, delivered IN, not only reach key pain-modulating regions in the nervous system but, in doing so, evoke significant analgesic effects. IN administration of polypeptides has tremendous potential to provide a non-invasive, rapid and effective method of delivery to the nervous system for chronic pain treatment and management.

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“…Many new treatment modalities for pain control are emerging and may have an upcoming role in the perioperative management of TJA [134][135][136][137][138][139][140][141][142][143][144][145][146][147] . Table II summarizes some of these treatments.…”

Section: On the Horizonmentioning

confidence: 99%

An Update on Multimodal Pain Management After Total Joint Arthroplasty

Karam

Schwenk

Parvızı

2021

Journal of Bone and Joint Surgery

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➤ Multimodal analgesia has become the standard of care for total joint arthroplasty as it provides superior analgesia with fewer side effects than opioid-only protocols.➤ Systemic medications, including nonsteroidal anti-inflammatory drugs, acetaminophen, corticosteroids, and gabapentinoids, and local anesthetics via local infiltration analgesia and peripheral nerve blocks, are the foundation of multimodal analgesia in total joint arthroplasty.➤ Ideally, multimodal analgesia should begin preoperatively and continue throughout the perioperative period and beyond discharge.➤ There is insufficient evidence to support the routine use of intravenous acetaminophen or liposomal bupivacaine as part of multimodal analgesia protocols.

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Intranasal Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Total Knee Arthroplasty Under General Anesthesia

Cited by 10 publications

References 30 publications

Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients

Intranasal Administration for Pain: Oxytocin and Other Polypeptides

An Update on Multimodal Pain Management After Total Joint Arthroplasty

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