Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis
Abstract Background Dexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few side effects. We report our experience with dexmedetomidine use during orthopaedic surgery under locoregional a...
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| Format: | Article |
| Language: | English |
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BMC
2022-12-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-022-00076-1 |
| _version_ | 1797977180018311168 |
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| author | Valerio Donatiello Aniello Alfieri Andrea Napolitano Vincenzo Maffei Francesco Coppolino Vincenzo Pota Maria Beatrice Passavanti Maria Caterina Pace Pasquale Sansone |
| author_facet | Valerio Donatiello Aniello Alfieri Andrea Napolitano Vincenzo Maffei Francesco Coppolino Vincenzo Pota Maria Beatrice Passavanti Maria Caterina Pace Pasquale Sansone |
| author_sort | Valerio Donatiello |
| collection | DOAJ |
| description | Abstract Background Dexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few side effects. We report our experience with dexmedetomidine use during orthopaedic surgery under locoregional anaesthesia to ensure adequate sedation and optimal postoperative pain control. Methods In this retrospective analysis, we included 128 patients who underwent orthopaedic surgery between January 2019 and December 2021. All patients received the same local anaesthetic dose of 20 ml of ropivacaine 0.375% + mepivacaine 0.5% for axillary and supraclavicular block and 35 ml of ropivacaine 0.375% + mepivacaine 0.5% for triple nerve block (femoral, obturator and sciatic nerve). The cohort was divided into two groups based on sedation drugs used during surgery (dexmedetomidine, or group D, vs midazolam, or group M). All patients received postoperative 24-h analgesia consisting of 60 mg of ketorolac, 200 mg of tramadol and 4 mg of ondansetron. The primary outcome measured how many patients in the two groups required an analgesic rescue dose of pethidine and the time to first pethidine administration. To reduce confounding, we included patients in two groups with non-statistically different demo-anamnestic parameters and who received the same dose of intraoperative local anaesthetic and postoperative analgesia. Results The number of patients in group D who did not require a rescue dose of analgesia was significantly greater than in group M (49 vs 11, p < 0.001). Time-to-first postoperative opioid administration did not show a fundamental difference between the two groups under examination (523.75 ± 131.55 min vs 564 ± 117.84 min). Total opioid consumption was higher in the M group than in the D group (3529.8 ± 30.36 μg vs 1864.8 ± 31.59 μg, p 0.075), with a mean opioid consumption significantly higher in the M group than in the D group (26.26 ± 42.8 μg vs 69.21 ± 46.1 μg, p < 0.001): D group received 62.06% less opioid than M group. Conclusions The continuous infusion of dexmedetomidine during orthopaedic surgery performed under locoregional anaesthesia has been shown to increase the analgesic effect of local anaesthetics and reduce the consumption of major opioids in the postoperative period. Dexmedetomidine offers a unique ability to supply sedation and analgesia without respiratory depression, having a wide safety margin and an excellent sedative capacity. It does not increase the rate of postoperative complications. |
| first_indexed | 2024-04-11T05:02:50Z |
| format | Article |
| id | doaj.art-27c01d0c5beb401189dbc12a39ea90e5 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-04-11T05:02:50Z |
| publishDate | 2022-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-27c01d0c5beb401189dbc12a39ea90e52022-12-25T12:33:58ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862022-12-01211610.1186/s44158-022-00076-1Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysisValerio Donatiello0Aniello Alfieri1Andrea Napolitano2Vincenzo Maffei3Francesco Coppolino4Vincenzo Pota5Maria Beatrice Passavanti6Maria Caterina Pace7Pasquale Sansone8Department of Elective Surgery, Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio CardarelliDepartment of Elective Surgery, Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio CardarelliDepartment of Elective Surgery, Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio CardarelliDepartment of Elective Surgery, Postoperative Intensive Care Unit and Hyperbaric Oxygen Therapy, A.O.R.N. Antonio CardarelliDepartment of Women, Child and General and Specialized Surgery, University of Campania Luigi VanvitelliDepartment of Women, Child and General and Specialized Surgery, University of Campania Luigi VanvitelliDepartment of Women, Child and General and Specialized Surgery, University of Campania Luigi VanvitelliDepartment of Women, Child and General and Specialized Surgery, University of Campania Luigi VanvitelliDepartment of Women, Child and General and Specialized Surgery, University of Campania Luigi VanvitelliAbstract Background Dexmedetomidine is a highly selective alpha-2 receptor agonist without any effect on the GABA receptor. It provides an excellent sedative and analgesic profile with few side effects. We report our experience with dexmedetomidine use during orthopaedic surgery under locoregional anaesthesia to ensure adequate sedation and optimal postoperative pain control. Methods In this retrospective analysis, we included 128 patients who underwent orthopaedic surgery between January 2019 and December 2021. All patients received the same local anaesthetic dose of 20 ml of ropivacaine 0.375% + mepivacaine 0.5% for axillary and supraclavicular block and 35 ml of ropivacaine 0.375% + mepivacaine 0.5% for triple nerve block (femoral, obturator and sciatic nerve). The cohort was divided into two groups based on sedation drugs used during surgery (dexmedetomidine, or group D, vs midazolam, or group M). All patients received postoperative 24-h analgesia consisting of 60 mg of ketorolac, 200 mg of tramadol and 4 mg of ondansetron. The primary outcome measured how many patients in the two groups required an analgesic rescue dose of pethidine and the time to first pethidine administration. To reduce confounding, we included patients in two groups with non-statistically different demo-anamnestic parameters and who received the same dose of intraoperative local anaesthetic and postoperative analgesia. Results The number of patients in group D who did not require a rescue dose of analgesia was significantly greater than in group M (49 vs 11, p < 0.001). Time-to-first postoperative opioid administration did not show a fundamental difference between the two groups under examination (523.75 ± 131.55 min vs 564 ± 117.84 min). Total opioid consumption was higher in the M group than in the D group (3529.8 ± 30.36 μg vs 1864.8 ± 31.59 μg, p 0.075), with a mean opioid consumption significantly higher in the M group than in the D group (26.26 ± 42.8 μg vs 69.21 ± 46.1 μg, p < 0.001): D group received 62.06% less opioid than M group. Conclusions The continuous infusion of dexmedetomidine during orthopaedic surgery performed under locoregional anaesthesia has been shown to increase the analgesic effect of local anaesthetics and reduce the consumption of major opioids in the postoperative period. Dexmedetomidine offers a unique ability to supply sedation and analgesia without respiratory depression, having a wide safety margin and an excellent sedative capacity. It does not increase the rate of postoperative complications.https://doi.org/10.1186/s44158-022-00076-1Locoregional anaesthesiaDexmedetomidineOpioid sparing anaesthesiaSedation |
| spellingShingle | Valerio Donatiello Aniello Alfieri Andrea Napolitano Vincenzo Maffei Francesco Coppolino Vincenzo Pota Maria Beatrice Passavanti Maria Caterina Pace Pasquale Sansone Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis Journal of Anesthesia, Analgesia and Critical Care Locoregional anaesthesia Dexmedetomidine Opioid sparing anaesthesia Sedation |
| title | Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis |
| title_full | Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis |
| title_fullStr | Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis |
| title_full_unstemmed | Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis |
| title_short | Opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery: a retrospective analysis |
| title_sort | opioid sparing effect of intravenous dexmedetomidine in orthopaedic surgery a retrospective analysis |
| topic | Locoregional anaesthesia Dexmedetomidine Opioid sparing anaesthesia Sedation |
| url | https://doi.org/10.1186/s44158-022-00076-1 |
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