The Effect of Intraoperative Dexmedetomidine Versus Morphine on Postoperative Morphine Requirements After Laparoscopic Bariatric Surgery

Zeeni, Carine; Aouad, Marie T.; Daou, Dayane; Naji, Sara; Jabbour-Khoury, Samar; Alami, Ramzi S.; Safadi, Bassem Y.; Siddik-Sayyid, Sahar M.

doi:10.1007/s11695-019-04074-1

Cited by 19 publications

(3 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were no cases of emergencies or agitation during recovery from anesthesia. Consistent with our results, Zeeni et al observed that dexmedetomidine and morphine infusions administered during laparoscopic bariatric surgery led to the same level of postoperative sedation [ 23 ]. Furthermore, Tufanogullari et al found no significant differences in postoperative sedation and time to extubation among three dexmedetomidine regimens and controls [ 24 ].…”

Section: Discussionsupporting

confidence: 92%

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

et al. 2023

View full text Add to dashboard Cite

Background Bariatric surgery depends on the development of novel anesthetic techniques to reduce the incidence of complications and improve postoperative outcomes. Ketamine and dexmedetomidine have been used for perioperative analgesia and we hypothesized that they would decrease postoperative morphine requirements. The objective of this trial is to study whether choice of ketamine or dexmedetomidine infusion would affect postoperative total morphine consumption. Methods Ninety patients were equally randomized into three groups. The ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min, followed by an infusion of the same drug (0.3 mg/kg/h). The dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min, followed by an infusion of this drug (0.5 mg/kg/h). The control group received a saline infusion. All infusions were given till 10 min before the end of surgeries. Intraoperative fentanyl was given when patient developed hypertension and tachycardia despite adequate anesthesia and muscle relaxation. Postoperative pain was managed by a rescue dose of 4 mg of IV morphine, with a minimum interval of 6 h between morphine doses if the numerical rating scale (NRS) score was ≥ 4. The primary outcome was the total morphine dose, and the secondary outcomes were intraoperative fentanyl requirement, time to extubation, postoperative nausea and vomiting (PONV), NRS scores, and modified observer’s agitation/sedation scale (MOASS) scores. Results Compared with ketamine, dexmedetomidine decreased the need for fentanyl intraoperatively (160 ± 42 µg), shortened the time to extubation (3 ± 1 min), and improved MOASS and PONV scores. In turn, ketamine decreased postoperative NRS scores and the need for morphine (3 ± 3 mg). Conclusions Dexmedetomidine treatment was associated with lower fentanyl doses, a shorter time to extubation, and better MOASS and PONV scores. Ketamine treatment was associated with significantly lower NRS scores and morphine doses. These results indicated that dexmedetomidine effectively decreased intraoperative fentanyl requirement and the time to extubation, while ketamine decreased the need for morphine. Trial registration This trail was registered on the clinicaltrials.gov registry (NCT04576975) on October 6, 2020.

show abstract

Section: Discussionsupporting

confidence: 92%

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

et al. 2023

View full text Add to dashboard Cite

show abstract

“…DEX improved both patient and anesthesiologist satisfaction and comfort during MAC procedure while requirements for midazolam and fentanyl were reduced [16]. In recent years, DEX also has been increasingly applied to general anesthesia as it helps attenuate sympathetic response and ensure intraoperative hemodynamic stability [17][18][19]. Bielka et al [5] conducted a trial about DEX infusion as an analgesic adjuvant during laparoscopic cholecystectomy, who came to a conclusion that intraoperative DEX infusion is effective for improving analgesia during and after operation and reduce postoperative morphine consumption.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

Liu¹,

Wang²,

Gao³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Dexmedetomidine(DEX) has proven to be an effective adjuvant to anesthetics owing to its sympatholytic, analgesic, and sedative properties. This study was designed to investigate the postoperative effects of continuous DEX infusion during gynecological laparoscopy and to evaluate the safety of this treatment. Methods: Sixty patients undergoing selective gynecological laparoscopy with general anesthesia were randomly assigned into DEX group (group D )and normal saline group (group N). DEX was infused at 0.5ug/kg/h during anesthesia maintenance in group D while normal saline was infused at the same rate in group N. The primary outcome measures were heart rate and blood pressure at extubation, 1, 2, 3, 4, 5, 6, 7, 8, 12, 24 and 48 hours after operation, NRS scores at 1, 2, 3 ,4, ,8,12,24 hours after surgery and OAA/S scores after extubation. The secondary outcome measures were time to extubation, propofol and remifentanil dosage during anesthesia, postoperative adverse events, and postoperative hospital stay.Results: Systolic and diastolic blood pressures were lower in group D at extubation when compared with group N (P<0.05), but not different at the first postoperative hour or after. HR was lower both at extubation and the first postoperative hour in group D (P<0.05). NRS scores were lower in patients given DEX both at rest and movement at the first postoperative hour (P<0.05). Time to extubation and OAA/S scores after extubation were not different between groups. Postoperative respiratory depression, shivering and pruritus didn’t occur in this research. There were no significant differences in the incidence rate of postoperative adverse events or postoperative hospital stay between the groups.Conclusions: Continuous infusion of DEX during gynecological laparoscopy provided better hemodynamic stability at extubation and the effects on HR continued until 1 hour after operation. DEX administration was associated with lower NRS scores at the first postoperative hour without excessive sedation. DEX is a useful and safe adjuvant for general anesthesia during gynecological laparoscopy.

show abstract

“…Secondary outcomes included hemodynamic vital signs during and after the surgery, time to release from PACU, the frequency of itching, nausea, and vomiting, respiratory problems in the PACU, and the quality of recovery using quality of recovery -40 score (QoR-40) at 24 h. The QoR-40 has been verified as an accurate instrument to evaluate the post-operative quality of recovery and contains 40 questions relating to five areas where 1 = very poor and 5 = excellent. It measures five dimensions : pain (35 points), physical comfort (60 points), emotional state (45 points), psychological support (35 points), and physical independence (25 points), with total scores ranging from 40 to 200 [12][13][14] .…”

Section: Secondary Outcomesmentioning

confidence: 99%

The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

Rashad,

el hefnawy,

Elmorshedi

et al. 2024

Ain-Shams Journal of Anesthesiology

View full text Add to dashboard Cite

Background: This study aimed to compare the efficacy and safety of combined intraoperative tramadol with pethidine versus pethidine alone and to assess their impact on post-operative pethidine requirements after laparoscopic sleeve gastrectomy (LSG). Methods and Results:This multicenter cohort research included 400 patients with morbid obesity who had LSG between January 2021 and December 2022. The patients included in the study were allocated to one of two treatment groups that were not randomized. Group A received only 1 mg/kg of pethidine before extubation. , while Group B got 1 mg/kg tramadol given when the surgeon started a gastric division with 1 mg/kg of pethidine before extubation. Doses were based on the patient's ideal body weight.The mean VAS pain score at 1, 3, 6, 12, and 24h after LSG was significantly reduced in group B (4.2, 2.89, 2.03, 1.69, and 0.26, respectively) compared to group A (5.1, 4.16, 3.21, 2.78, and 0.44). Postoperative nausea and vomiting (PONV) were higher in group A at 3 and 6 h after LSG. Opioid consumption in the postoperative period was less in Group B than in Group A. There was a significant reduction in the requirement for on-demand metoclopramide and ondansetron in group B. Oxygen desaturation (<92) significantly developed in group A after surgery and was managed using an oxygen mask. Post-operative bradycardia was significantly observed in group B after LSG. Conclusion: Intraoperative tramadol with pethidine provides superior post-operative analgesia and safety over Intraoperative pethidine alone.

show abstract

The Effect of Intraoperative Dexmedetomidine Versus Morphine on Postoperative Morphine Requirements After Laparoscopic Bariatric Surgery

Cited by 19 publications

References 37 publications

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

The effect of intraoperative tramadol on post-operative opioid requirements after laparoscopic sleeve gastrectomy for morbidly obese patients: A retrospective multicentric cohort study

Contact Info

Product

Resources

About