Intravenous infusion of dexmedetomidine amplifies thoracic epidural analgesic effect after open thoracotomy

Choi, Eun‐Ji; Yoon, Jung Pil; Choi, Yun-Mi; Park, Ju Yeon; Kim, Hee Young; Byeon, Gyeong-Jo

doi:10.1097/md.0000000000017983

Cited by 9 publications

(9 citation statements)

References 22 publications

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“…Thoracic paravertebral nerve block anesthesia is a commonly used anesthesia method in thoracic surgery, with a high safety profile. It is also conducive to maintaining hemodynamic stability and analgesic effect [ 3 ]. Ropivacaine is a commonly used local anesthesia drug characterized by convenient use and ideal analgesic effect, while dexmedetomidine is a highly selective adrenergic α 2 receptor agonist with a good efficacy profile in antianxiety, sedation, and analgesia [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Baoli¹,

Yang²,

Shi³

2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the effect of different doses of dexmedetomidine combined with thoracic paravertebral nerve block anesthesia on agitation and hemodynamics in patients undergoing thoracotomy during recovery. Methods. One hundred patients who underwent thoracotomy in our hospital from August 2018 to April 2021 were enrolled and assigned (1 : 1 : 1 : 1) into 4 groups via the random number table method. The patients in the control group were treated with double-lumen tube general anesthesia + ropivacaine for thoracic paravertebral nerve block anesthesia; patients in experimental group A received double-lumen general anesthesia +0.5 μg·kg−1 dexmedetomidine + ropivacaine for thoracic paravertebral nerve block anesthesia; patients in experimental group B received thoracic paravertebral nerve block anesthesia with double-lumen general anesthesia +1.0 μg·kg−1 dexmedetomidine + ropivacaine; patients in experimental group C received thoracic paravertebral nerve block anesthesia with double-lumen general anesthesia +1.5 μg·kg−1 dexmedetomidine + ropivacaine. The postoperative recovery time and visual analog scale (VAS), level of hemodynamics (heart rate (HR), mean arterial pressure (MAP)), agitation during the recovery period, and complications were compared amongst the 4 groups of patients at different time points. Results. The postoperative VAS scores of patients in groups B2 and B3 were slightly lower than those of patients in groups A and B1, but a one-way analysis of variance revealed no statistical difference in the postoperative recovery time and VAS pain scores of the four groups ( P > 0.05 ), and the recovery time of patients in experimental group C was slightly higher than that of patients in group B2. At T0 and T1, there was no significant difference in the levels of HR and MAP among the four groups ( P > 0.05 ). The levels of HR and MAP of the patients in groups B2 and B3 were significantly different from the patients in the control group and experimental group A at T2 and T3 ( P < 0.05 ). The patients in experimental group B and experimental group C showed better outcomes than those in the control group and experimental group A in the assessment of agitation during the recovery period ( P < 0.05 ). There was no significant difference in the incidence of complications among the four groups ( P > 0.05 ). Conclusion. In line with the principle of preference for a small anesthesia dose, 1.0 μg·kg−1 dose of dexmedetomidine combined with ropivacaine produces a pronounced efficacy in patients undergoing thoracotomy. It effectively controls the occurrence of agitation during the recovery period and maintains the stability of the patient’s hemodynamics, with a high clinical safety profile.

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Section: Introductionmentioning

confidence: 99%

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Baoli¹,

Yang²,

Shi³

2022

Evidence-Based Complementary and Alternative Medicine

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“…Literature Findings. The literature supports the use of intravenous dexmedetomidine as an analgesic adjunct intraoperatively [112][113][114][115] and/or postoperatively 113,114,116,117 for patients undergoing thoracic surgery via VATS 112,113,115,117 and thoracotomy 114,116,117 as it reduces pain scores 112,114,116 and/or opioid 113,[115][116][117] consumption (Category A2-B evidence).…”

Section: A 2 Ementioning

confidence: 94%

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

Makkad

Heinke

Sheriffdeen

et al. 2023

Anesthesia &Amp; Analgesia

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Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee’s Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use–focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.

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“…Dexmedetomidine is a central alpha-2-agonist with sedative, analgesic and opioid-sparing properties (59). One study illustrated that a low-dose intravenous infusion of dexmedetomidine initiated before the end of surgery and continued for 12 h after thoracotomy amplified TEA (60). Patients receiving dexmedetomidine expressed lower Visual Analog Pain (VAS) scores during the first 48 h after surgery despite using fewer opioid analgesics.…”

Section: Part 2: Multimodal Analgesiamentioning

confidence: 99%

“…Additionally, this effect is further enhanced by the addition of perineural dexamethasone (62). Intraoperative dexmedetomidine also reduces the incidence of emergence agitation and cough after thoracic surgery, although, time to awakening from anesthesia may be prolonged and bradycardia may be observed (60,61,63). Dexmedetomidine presents significant benefits in terms of analgesia and quality of recovery after thoracic surgery and its use should be considered.…”

Section: Part 2: Multimodal Analgesiamentioning

confidence: 99%

Perioperative pain management for thoracic surgery: a narrative review of the literature

Clairoux¹,

Issa²,

Bélanger³

et al. 2023

Curr Chall Thorac Surg

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The objective of this article was to review the evidence regarding multimodal analgesia drugs and regional block techniques in the context of thoracic surgery, with a special focus on video-assisted thoracic surgery (VATS).Background: Despite advances in surgical technique and the increased use of minimally invasive surgery, postoperative pain after thoracic surgery is still significant, especially in the first two postoperative days.Inadequate pain control leads to a reduced rate of pulmonary recovery which can lead to atelectasis, hypoxemia and pneumonia and is significantly linked to an increased incidence of chronic postsurgical pain.However, the optimal analgesic protocol that allows adequate postoperative pain control and facilitates fast recovery of this population has yet to be determined.Methods: An extensive review of articles published between January 1980 and November 2020 using different combinations of search terms that were relevant to the topic was conducted using PubMed search engine. All published full articles randomised controlled trials comparing the analgesic efficacy of a regional block or of a multimodal analgesic drug to a placebo in patients undergoing either thoracotomy or VATS were included in this review.Conclusions: Analgesic protocols in thoracic surgery must take into consideration the surgery that is being performed (VATS or thoracotomy) as well as patient's characteristics. Regional blocks are highly effective at providing good postoperative pain control although their duration is limited. Various non opioid analgesic drugs have been evaluated in order to address the various pain generators that cause postoperative pain after thoracic surgery, although none has become a clinical standard. Using a combined multimodal and regional analgesic protocol could improve postoperative pain control and decrease the use of parenteral opioids and their unwanted side effects. Recommendations on multimodal analgesic protocols are given based on the literature.

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Intravenous infusion of dexmedetomidine amplifies thoracic epidural analgesic effect after open thoracotomy

Cited by 9 publications

References 22 publications

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Effects of Different Doses of Dexmedetomidine Combined with Thoracic Paravertebral Nerve Block Anesthesia on Agitation and Hemodynamics in Patients Undergoing Thoracotomy during Recovery

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

Perioperative pain management for thoracic surgery: a narrative review of the literature

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