Intraoperative Dexmedetomidine Reduces Postoperative Opioid Consumption

Intraoperative administration of a fixed dose of dexmedetomidine is associated with a 35% decrease in postoperative opioid use and faster discharge from the post-anaesthesia care unit (PACU) in patients undergoing minimally invasive thoracic surgery, according to prospective research presented at the 2017 Annual Meeting of the American Society of Anesthesiologists (ASA).

Multimodal analgesia is commonly used to reduce the use of opioids and expedite patient discharge. While dexmedetomidine has been shown to have a 30% opioid-sparing effect when given 4 hours after gynaecologic surgery, it also was associated with sedation, hypotension, and bradycardia, noted lead author Alessia Pedoto, MD, Memorial Sloan-Kettering Cancer Center, New York, New York, speaking here on October 24.

Dr. Pedoto and colleagues divided 279 patients into 2 groups: those who were receiving either dexmedetomidine (n = 134) or placebo (n = 145), both infused at 0.4 mcg/kg/hour from the induction of general anaesthesia until the time of wound closure.

The clinical endpoints of the study were intraoperative and postoperative opioid consumption at the end of the case, and at 4, 8, and 23 hours; postoperative pain scores; and time until PACU discharge.

The researchers found that the dexmedetomidine group received less intraoperative and postoperative morphine equipment at 4 hours, with no difference at 8 and 23 hours.

They also found that pain scores, non-opioid requirements, and postoperative nausea and vomiting scores were not statistically different between the 2 groups.

As for time in PACU, the placebo group stayed for a median of 5 hours compared with a median of 3 hours for the dexmedetomidine group.

Dr. Pedoto and colleagues suggested that dexmedetomidine should be considered as an additional adjuvant for minimally invasive thoracic surgery and enhanced recovery pathways.

[Presentation title: Opioid Sparing Effect of Intraoperative Dexmedetomidine in Patients Undergoing Minimally Invasive Thoracic Surgery. Abstract #4167]