American Society of Regional Anesthesia and Pain Medicine August 2018 - 34
Table 1: Studies of perioperative dexmedetomidine and its effect on analgesia.
Author, year
Sample size
Surgery
Comparison
Outcome
Fan, 2017
N = 45
Radical mastectomy
1. Propofol/remifentanil/LR
2. Propofol/remifentanil/dex
1. Morphine-sparing effect
2. Decreased postoperative
pain score
Tufanogullari, 2008
N = 80
Laparoscopic bariatric
surgery
1.
2.
3.
4.
1. Decreased opioid analgesic
in PACU
2. Reduced PACU stay
3. No difference in pain scores
in PACU or on PODs 1, 2,
and 7
Ge, 2016
N = 64
Abdominal hysterectomy
1. Propofol/remifentanil/NS
2. Propofol/remifentanil/dex
1. Decreased pain scores in
first 24 h
2. Decreased morphine PCA
requirement
Ge, 2015
N = 67
Abdominal colectomy
1. Propofol/remifentanil/NS
2. Propofol/remifentanil/dex
1. Decreased pain scores
(significant at 8, 12, and 24 h
postoperatively)
2. Decreased morphine PCA
requirement
Rajan, 2016
N = 139
Craniotomy
1. Dex infusion
2. Remifentanil infusion
1. Decreased pain scores in
PACU
2. Decreased opioid
requirements in PACU
Hwang, 2015
N = 37
Posterior lumbar
interbody fusion
1. Propofol/remifentanil
2. Propofol/dex
1. Decreased pain scores in
PACU and at 2, 8, 24 and 48
h postoperatively
2. Decreased PCA requirement
Naik, 2016
N = 131
Major spine surgery
1. Dex (loading dose followed
by continuous infusion)
2. Saline
1. No difference in pain scores
2. No significant differences in
opioid consumption
Wang, 2016
N = 36
Laparoscopic
gynecologic surgery
None intraoperatively
1. Dex PCA
2. Fentanyl PCA
1. No significant difference in
pain scores at 4, 6, 8, 24,
and 48 h postoperatively
2. Increased patient satisfaction
with pain management with
dex
Saline
Dex 0.2 μg/kg/h IV
3. Dex 0.4 μg/kg/h IV
4. Dex 0.8 μg/kg/h IV
Abbreviations: Dex, dexmedetomidine; IV, intravenous; LR, lactated Ringers; NS, normal saline; PACU, postanesthesia care unit; PCA, patient-controlled
analgesia; POD, postoperative day.
demonstrated decreased postoperative opioid consumption with
decreased postoperative pain scores.13,14
A study by Naik et al15 compared intraoperative dexmedetomidine
to placebo in patients undergoing major spine surgery and
failed to demonstrate a statically significant difference between
postoperative opioid consumption and pain scores, although the
authors found a modest but significant reduction in intraoperative
34
opioid consumption. Wang et al16 provided a unique study design
in which dexmedetomidine was administered as postoperative PCA
to patients undergoing laparoscopic gynecologic surgery. Neither
the fentanyl PCA nor dexmedetomidine PCA group required rescue
analgesia. Patients receiving postoperative dexmedetomidine had
higher pain control satisfaction scores, a decreased incidence of
postoperative nausea and vomiting (PONV), and faster recovery of
bowel function.16
American Society of Regional Anesthesia and Pain Medicine
2018
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