Original contributionClinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery
Introduction
Dexmedetomidine1, the pharmacologically active dextroisomer of medetomidine, is a selective α2-adrenoceptor agonist currently used for its sedative, analgesic, and sympatholytic properties [1], [2], [3], [4]. Dexmedetomidine induces analgesia by action at the locus coeruleus [5], [6] and at the spinal cord, inhibiting nociceptive process. This pathway is mediated by α2A-adrenoceptor subtypes [7], [8], [9]. Dexmedetomidine becomes an attractive alternative to the current opioid analgesics because it does not have a respiratory depressant effect or addictive potential [3], [4], [5], [6], [7], [8], [9], [10]. To date, there are few controlled studies published about the analgesia-sparing effect of dexmedetomidine as a primary end point in the early postoperative period [11], [12]. Knee arthroscopy is currently a surgical procedure with a short discharge time and low operative morbidity; however, this procedure may be associated with postoperative pain, and the administration of analgesics is necessary [13], [14]. Thus, we evaluated dexmedetomidine in controlling early postsurgical pain, comparing its efficacy and side effects in patients undergoing knee arthroscopy.
Section snippets
Design and patients
This study was designed as a double-blind, double-placebo, randomized, parallel-group protocol performed in accordance with the International Conference on Harmonization Good Clinical Practice guidelines [15]. After approval by the Instituto Mexicano del Seguro Social (Institutional Review Board), signed informed consent was obtained from all patients before enrollment. Criteria for selection included ASA physical status I, II, and III patients (age range, 18 to 60 years) who suffered from
Demographic and clinical data
Of the 30 patients initially enrolled in the study, 20 (66%) were men. Patients' demographic and clinical characteristics and type of surgery did not differ between groups (Table 1). The only significant difference was length of surgery for the dexmedetomidine group (P = 0.04). With respect to physical status, in the dexmedetomidine group, 7 patients were ASA physical status I, 7 patients ASA physical status II, and one patient ASA physical status III. Patient comorbidities were essential
Discussion
To explore the analgesic usefulness of dexmedetomidine for acute pain, we chose a model of arthroscopic knee surgery. To validate the possible analgesic efficacy of dexmedetomidine, we used an active comparison (propacetamol), which provides analgesia and has been used for short-term management of postoperative pain [18].
In this trial, we found that dexmedetomidine provides analgesia early in the postoperative period in patients undergoing knee arthroscopy. This analgesic efficacy was not
References (23)
- et al.
Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care
Br J Anaesth
(2002) - et al.
Intramuscular dexmedetomidine as premedication for general anesthesia. A comparative multicenter study
Anesthesiology
(1993) - et al.
Dexmedetomidine premedication for minor gynecologic surgery
Anesth Analg
(1990) - et al.
[Alpha]2-adrenoceptor agonists in anaesthesia: a new paradigm
Curr Opin Anaesthesiol
(2000) - et al.
Clinical uses of α2-adrenergic agonists
Anesthesiology
(2000) - et al.
Different [alpha]2 adrenoceptor subtypes control noradrenaline release and cell firing in the locus coeruleus of wildtype and monoamine oxidase—a knockout mice
Eur J Neurosci
(2003) - et al.
Substitution of a mutant α2a-adrenergic receptor via “hit and run” gene targeting reveals the role of this subtype in sedative, analgesic and anesthetic-sparing responses in vivo
Proc Natl Acad Sci U S A
(1997) - et al.
The α2a-adrenergic receptor subtype mediates spinal analgesia evoked by α2 agonists and is necessary for spinal adrenergic-opioid synergy
J Neurosci
(1997) - et al.
α2-Adrenoceptors in pain modulation: which subtype should be targeted to produce analgesia?
Anesthesiology
(2000) - et al.
Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care
Crit Care
(2000)
Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation
Anesth Analg
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2020, Veterinary Anaesthesia and AnalgesiaIntra-articular versus intravenous administration of dexmedetomidine in arthroscopic knee surgeries under local anesthesia: A prospective randomized study
2018, Egyptian Journal of AnaesthesiaCitation Excerpt :The haemodynamic stability with intra-articular dexmedetomidine rather than the intravenous injection, due to the difference of absorption of drug from poorly vascular articular surface or systemic. This is in compatible with the other studies [10,11]. Since Pevey et al. [22], were the first to report knee arthroscopy under local anaesthesia in 1978; then there has been a shifting trend from the administration of the local anesthetics from regionally towards its usage locally.
Effects of xylazine and dexmedetomidine on equine articular chondrocytes in vitro
2017, Veterinary Anaesthesia and AnalgesiaCitation Excerpt :Some adverse effects of the most commonly used local anaesthetics (e.g. bupivacaine, lidocaine) have been reported in the chondrocytes of humans and animals in vivo and in vitro (Ballieul et al. 2009; Chu et al. 2010; Park et al. 2011; Baker & Mulhall 2012). Recently, IA administration of α2-agonists such as dexmedetomidine in humans (Gomez-Vazquez et al. 2007; Al-Metwalli et al. 2008; Paul et al. 2010; Alipour et al. 2014) and dogs (Soto et al. 2014) and xylazine in horses (Di Salvo et al. 2014) has been shown to ameliorate postoperative outcomes after arthroscopy. Similarly, IA detomidine provided analgesia in horses after experimentally induced lameness (Sardari et al. 2005).
American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Sedation and Respiratory Depression
2011, Pain Management NursingCitation Excerpt :Similar results were shown with a comparison of an intraoperative infusion of dexmedetomidine and placebo (Gurbet, Basagan- Mogol, Turker, Ugun, Kaya, & Ozcan 2006). The adverse effect profile for dexmedetomidine does not typically include respiratory depression (Hsu, Cortinez, Robertson, Keifer, Sum-Ping, et al., 2004); however, patients given an IV infusion of dexmedetomidine and supplemental IV morphine after surgery in one RCT demonstrated lower oxygen saturation readings and higher sedation scores while in the PACU than those who received an IV infusion of acetaminophen and supplemental IV morphine after surgery (Gomez-Vasquez, Herndez-Salazar, Hernadez-Jimenez, Perez-Sanchez, Zepeda-Lopez, & Salazar-Paramo, 2007). Another RCT reported a lower incidence of respiratory depression in the PACU for patients who had a loading dose of dexmedetomidine followed by a dexmedetomidine infusion compared with a placebo loading dose followed by dexmedetomidine before major surgery (Candiotti, Bergese, Bokesch, Feldman, Wisemandle, et al., 2010).
The Changing Landscape of Perioperative Pain Management
2011, Journal of Perianesthesia NursingComparative study between novel sedative drug (dexmedetomidine) versus midazolam-propofol for conscious sedation in pediatric patients undergoing oro-dental procedures
2010, Egyptian Journal of AnaesthesiaCitation Excerpt :Arian et al. [20] demonstrated that dexmedetomidine was superior than patients receiving morphine alone for postoperative analgesia. The analgesic effects of dexmedetomidine had also been appreciated in various settings and various patient populations [21–26]. In summary, we can tell that both sedative techniques were safe and effective and can be used to alleviate anxiety, unwanted movements and provide adequate sedation for pediatrics undergoing dental procedures.