The optimal dose of dexmedetomidine added to an sufentanil-based analgesic regimen for postoperative pain control in spine surgery

Abstract

Postoperative spinal patients remain a challenge for provision of postoperative analgesia. Patient-controlled intravenous analgesia (PCIA) is a major method in reducing the severe pain after the surgery in our institution, but some adverse effects prevent the use of adequate dosage opioids.This study was determined using the probit analysis to investigate the optimal dose of dexmedetomidine (DEX) infusion for postoperative analgesia combined with sufentanil (SUF) in spine surgery.The dose of DEX needed to produce satisfactory analgesia conditions following combination of 3.0 μg/kg SUF in PCIA pump, which was diluted to 250 mL with a 4 mL/h as background infusion. Patients were recruited with age 35 to 65 years. The satisfactory criteria of postoperative analgesia were determined with a average satisfaction level of pain control, sedation, self-satisfaction, and adverse effects, among others. The dose of DEX was determined using the modified Dixon's up-and-down method (0.5 μg/kg as a step size). The first patient was test at 3.0 μg/kg DEX. The patient was assessed at 6, 12, 36 hours, and termination of PCIA following the continuous infusion of DEX-SUF mixture in PCIA after surgery.Twenty-five patients were enrolled by predetermined criteria. The optimal dose of DEX required for satisfactory analgesic was 4.33 (SD, 0.38) μg/kg combined with 3.0 μg/kg SUF via a PCIA volume of 250 mL by background infusion of 4 mL/h. Using probit analysis, the ED50 of DEX was 4.12 μg/kg (95% confidence limits 3.74–4.52 μg/kg) for satisfactory postoperative analgesic in spine surgery, the ED95 of DEX was 4.85 μg/kg (95% confidence limits 4.48–7.13 μg/kg). There was no report of somnolence or respiratory depression, relevant bradycardia or hypotension, or over sedation in this study.The optimal dose of DEX was 4.33 (0.38) μg/kg−1 combined with 3.0 μg/kg−1 SUF diluted to 250 mL with a background infusion of 4 mL/h for satisfactory analgesic after spine surgery. From probit analysis, ED50 and ED95 of DEX were 4.12 μg/kg (95% confidence limits 3.74–4.52 μg/kg) and 4.85 μg.kg−1 (95% confidence limits 4.48–7.13 μg/kg), respectively.

Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy intravenous analgesia:a randomized, controlled clinical study

“…A wider therapeutic index in sufentanil has been demonstrated compared with other commonly used opioids for PCIA, and sufentanil is not processed into active metabolites [ 24 , 25 ]. Also, the optimal dose of dexmedetomidine combining with sufentanil is vital and clinically the analgesic and sedation is satisfied maximumly, and the consumption of sufentanil is reported to be reduced when administered together with dexmedetomidine [ 26 ]. A recent study in vivo have showed that a lower loading dose of dexmedetomidine (<10 μg/kg) prevent response to noxious stimulation mainly via enhanced inhibitory postsynaptic transmission within the superficial dorsal horn without altering excitatory synaptic transmission or evoking direct postsynaptic membrane currents.…”

Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine with Magnesium Sulfate

“…In the current study, less opioid was required in the DEX group than the Mg group. Many studies showed that dexmedetomidine reduced opioid ( 9 , 10 , 13 , 14 ) requirements during and after the operation. Dexmedetomidine exerts its analgesic effect through α2 receptors in the locus coeruleus and spinal cord ( 46 ).…”

“…It results in a decrease in heart rate (HR) and cardiac output accordingly ( 11 ), whereas no decrease in stroke volume occurs unless the plasma concentrates reaches above 5.1 µg/mL ( 12 ). This drug also has sedative ( 12 ), amnesic, anxiolytic, hypnotic, and analgesic ( 13 , 14 ) effects with minimal changes in respiratory variables ( 12 , 15 ). Furthermore, it reduces postoperative nausea ( 13 ), vomiting ( 16 ), and shivering ( 17 , 18 ).…”

hole-Course Application of Dexmedetomidine Combined with Ketorolac in Nonnarcotic Postoperative Analgesia for Patients with Lung Cancer Undergoing Thoracoscopic Surgery: A Randomized Control Trial

“…DEX, as an adjuvant analgesic, is widely used to improve the patients' pain states, sedation, and sleep quality (13). Recently, DEX was added to opioid-based PCIA and proved to reduce opioids consumption and opioid-related adverse effects, provide stable hemodynamics, and effective postoperative analgesia (14,15). One research studied the optimal dose of DEX combined with SUF in PCIA in patients undergoing spinal surgery.…”