Real-time evaluation of the independent analgesic efficacy of dexmedetomidine

Abstract

Background Dexmedetomidine has analgesic properties, but the intraoperative analgesic effect of dexmedetomidine is often masked by the effects of other general anaesthetics. Therefore, the degree to which it reduces intraoperative pain intensity remains unclear. The objective of this double-blind, randomised controlled trial was to evaluate the independent intraoperative analgesic efficacy of dexmedetomidine in real-time. Methods This single-centre study enrolled 181 patients who were hospitalised for below-knee orthopaedic surgeries between 19 January 2021 to 3 August 2021 were eligible for this is single-centre study. Peripheral neural block was performed on patients scheduled for below-knee orthopaedic surgeries. Patients were randomly assigned to the dexmedetomidine or midazolam group and were intravenously administered with 1.5 µg kg−1 h−1 dexmedetomidine or 50 µg kg−1 h−1 midazolam, respectively. The analgesic efficacy was evaluated using the real-time non-invasive nociception monitoring. The primary endpoint was the attainment rate of the nociception index target. The secondary endpoints included the occurrence of intraoperative hypoxemia, haemodynamic parameters, the consciousness index, electromyography and patient outcomes. Results On Kaplan–Meier survival analysis, the defined nociception index target was attained in 95.45% and 40.91% of patients receiving dexmedetomidine and midazolam, respectively. Log-rank analysis revealed that the dexmedetomidine group attained the nociception index target significantly faster and the median attainment time of the nociception index target in the dexmedetomidine group was 15 min. Dexmedetomidine group was associated with a significantly lower incidence of hypoxemia. There was no significant difference in blood pressure between the dexmedetomidine and midazolam groups. Further, the dexmedetomidine group had a lower maximum visual analogue scale score and lower analgesic consumption postoperatively. Conclusions Dexmedetomidine has independent analgesia and systemically administered as an adjuvant agent has better analgesic efficacy than midazolam without severe side effects. Trial registration clinicaltrial.gov Registry Identifier: NCT-04675372.Registered on 19/12 /2020.

Postoperative Sedation Options in ICU

“…found in a randomized controlled trial on the effects of dexmedetomidine and midazolam on cough and quality of recovery after partial and total laryngectomy that dexmedetomidine is an effective alternative drug in reducing cough and hemodynamic changes, and has a lower incidence of adverse events during the anesthesia recovery period after partial or total laryngectomy [39]. Similarly, an RCT study on the real-time evaluation of the independent analgesic efficacy of dexmedetomidine by XH Wang et al found that dexmedetomidine has an independent analgesic effect, and systemic administration as an auxiliary drug is more effective than midazolam, providing a better analgesic effect without serious side effects [40]. In addition to its sedative and anti-delirium effects, dexmedetomidine has been discovered to reduce inflammatory response, stress, promote postoperative gastrointestinal function recovery, and reduce postoperative chills after cesarean section, among other benefits [41] [42] [43] [44].…”

Ultrasound‑guided erector spinae plane block in posterior lumbar surgery (Review)

“…Previous studies also revealed that the application of dexmedetomidine combined with LAs in nerve and fascia blocks could accelerate block onset, prolong block duration, enhance analgesic effects and significantly reduce opioid consumption (37,38). The locking mechanism could be as follows: Dexmedetomidine is an imidazole derivative with a prolonged analgesic action (39). It has been reported that it can promote vasoconstriction, delay the absorption of LAs and prolong the effect of Las (40).…”