Original contribution
Clinical analgesic efficacy and side effects of dexmedetomidine in the early postoperative period after arthroscopic knee surgery

https://doi.org/10.1016/j.jclinane.2007.06.013Get rights and content

Abstract

Study Objectives

To determine the analgesic efficacy of dexmedetomidine in the early postoperative period.

Design

Randomized, double-blind, double placebo-controlled clinical trial.

Setting

University medical center.

Patients

30 ASA physical status I, II, and III patients with cruciate ligament lesion and joint fibrosis who were scheduled for knee arthroscopy.

Interventions

Patients were prospectively randomized to receive dexmedetomidine one mcg/kg−1 intravenously (IV), for 10 minutes followed by dexmedetomidine 0.3 mcg/kg−1 for 50 minutes or propacetamol two g, IV, for 10 minutes.

Measurements

Pain scores, time to onset analgesia, and morphine consumption were measured. Open-label rescue morphine 5 mg IV was available as needed during the postdosing evaluation period of 8 hours. Hemodynamic data, sedation scores, and renal and hepatic function were assessed for control of adverse events.

Main Results

Pain scores with dexmedetomidine and propacetamol were similar. There were no differences in the number of patients who required supplemental rescue analgesia (7/15 vs 4/15; P = 0.44), but total morphine requirements were higher with dexmedetomidine (45 mg) versus propacetamol (20 mg) in the 8-hour follow-up (P < 0.05). The most frequent adverse events with dexmedetomidine were bradycardia and hypertension.

Conclusions

Dexmedetomidine provides a modest analgesic effect after knee arthroscopy, but the side effects of this drug, such as hypertension and bradycardia, may restrict the use of large bolus doses.

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

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