Effects of Deep Sedation With Dexmedetomidine Versus Remifentanil on Postoperative Recovery in Soft Tissue Surgery

Background

Soft tissue surgery comprises short or medium-duration surgical procedures, with anesthesia consisting of analgesia and sedation. Various quantitative and qualitative recovery scales are used to evaluate the quality of postoperative recovery. The primary objective of this study was to compare the effects of dexmedetomidine versus remifentanil on postoperative recovery using the Quality of Recovery-15 (QoR-15) scale to assess recovery quality in soft tissue surgeries.

Methodology

This prospective randomized study was conducted at the Clinic of Anesthesia, Reanimation and Intensive Care and University Clinic of Reconstructive and Plastic Surgery, Skopje, Republic of North Macedonia, involving 80 patients. Patients were randomly assigned into two groups, namely, Group 1, sedated with intraoperative dexmedetomidine infusion (Dex, n = 40), and Group 2, sedated with intraoperative remifentanil infusion (Rem, n = 40). Intraoperatively, hemodynamic and respiratory parameters were measured. Preoperatively and postoperatively, levels of leukocytes, blood sugar, and the QoR-15 score were determined. Postoperative mean arterial pressure (MAP), postoperative pain (Visual Analog Scale), and sedation level (Richmond Agitation-Sedation Scale) were compared with the quality of postoperative recovery scores (QoR-15) using Pearson’s correlation coefficient.

Results

The results indicated that dexmedetomidine provided prolonged postoperative sedation and analgesia, which dissipated shortly thereafter, while patients sedated with remifentanil experienced pain immediately upon awakening and required more analgesics. The correlation analysis showed a negative relationship between the degree of postoperative pain and sedation and the quality of recovery.

Conclusions

Dexmedetomidine demonstrated a superior performance compared to remifentanil. Hence, dexmedetomidine in soft tissue surgery ensures hemodynamic stability, shows protective anti-inflammatory and anti-stress effects, provides good postoperative analgesic effects, reduces recovery time, and protects the body from undesirable postoperative complications.