The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Abstract

IntroductionAcute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics.ObjectiveTo review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain.MethodsMedline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements.ResultsFrom 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension.ConclusionDexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.

Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: a retrospective study

“…However, the OFA protocol used in our patients was substantially different and was based on a pre-induction mixture of intravenous infusion of dexmedetomidine, magnesium sulfate and lidocaine. Dexmedetomidine has been well studied as an adjunct in balanced anaesthesia for cardiac surgery but no previous study has ever evaluated the benefit of dexmedetomidine-based OFA strategy [ 16 , 17 ]. A safety and an efficient analgesic effect of dexmedetomidine in cardiothoracic surgery has been previously reported [ 16 ].…”

“…Dexmedetomidine has been well studied as an adjunct in balanced anaesthesia for cardiac surgery but no previous study has ever evaluated the benefit of dexmedetomidine-based OFA strategy [ 16 , 17 ]. A safety and an efficient analgesic effect of dexmedetomidine in cardiothoracic surgery has been previously reported [ 16 ]. The hemodynamic effects of lidocaine have been previously investigated in cardiac surgical patients [ 26 ].…”

“…One retrospective study compared an OFA (protocol combining propofol-lidocaine-ketamine-dexamethasone) to an opioid-based anaesthesia (OBA) with sufentanil and regional anaesthesia [15]. Recent data suggest that dexmedetomidine added to a balanced anaesthesia protocol in cardiac surgical patients could reduce opioid consumption, postoperative pain and duration of mechanical ventilation [16,17]. Interestingly, dexmedetomidine administration through this approach may also reduce postoperative myocardial injury, incidence of new onset of arrythmias and even postoperative mortality up to 1 year after cardiac surgery [18].…”

Analgesia after cardiac surgery

“…Что касается его анальгетического эффекта, то на данный момент проведено уже достаточно исследований на эту тему. В систематическом обзоре 2018 г. по влиянию дексмедетомидина на выраженность послеоперационного болевого синдрома после кардиоторакальных вмешательств (выполненных посредством торакотомии или стернотомии) показано, что у пациентов, получавших дексмедетомидин, интенсивность боли была значительно ниже [67]. Из отобранных 12 исследований, включающих 804 пациента, в 2 сообщалось о значительном снижении потребности в послеоперационной аналгезии дополнительными средствами, в 1 -о значительном снижении частоты возникновения эпизодов острой боли у пациентов, получавших дексмедетомидин.…”

“…В 10 исследованиях показано, что общее потребление наркотических анальгетиков было значительно ниже у пациентов, получавших дексмедетомидин. Из осложнений наиболее часто регистрировались тошнота/рвота, брадикардия и артериальная гипотензия, а также чрезмерная седация, однако частота депрессии дыхания встречалась значительно реже у пациентов, получавших дексмедетомидин, что связано с отсутствием влияния на дыхательный центр и опосредовано через снижение об-щего потребления опиоидов [67]. Важно, что более выраженный анальгетический и опиоидсберегающий эффекты отмечены в тех исследованиях, в которых введение дексмедетомидина начиналось еще в операционной, нежели только в послеоперационном периоде.…”