Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-25T06:24:41.579Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine

Published online by Cambridge University Press:  11 May 2005

H. Unlugenc ,
M. Gunduz ,
T. Guler ,
O. Yagmur  and
G. Isik
H. Unlugenc
Affiliation:
Cukurova University Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
M. Gunduz
Affiliation:
Cukurova University Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
T. Guler
Affiliation:
Cukurova University Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
O. Yagmur
Affiliation:
Cukurova University Faculty of Medicine, Department of General Surgery, Adana, Turkey
G. Isik
Affiliation:
Cukurova University Faculty of Medicine, Department of Anaesthesiology, Adana, Turkey
Get access

Extract

Summary

Background and objective: This prospective, randomized, double-blind, controlled study was designed to test the effect of pre-anaesthetic administration of dexmedetomidine, given as a single intravenous (i.v.) dose, on postoperative pain scores and morphine consumption in patients receiving patient-controlled morphine after abdominal surgery.

Methods: Sixty patients were randomly allocated to receive dexmedetomidine (1 μg kg−1) or saline 10 min before induction of anaesthesia. Twenty minutes before the end of surgery, all patients received a standardized (0.1 mg kg−1) loading dose of morphine. They were then allowed to use a patient-controlled analgesia (PCA) device giving bolus doses of morphine (0.02 mg kg−1). Pain, discomfort and sedation scores; cumulative morphine consumption; time to extubation; time to recovery; and any side-effects were recorded after recovery and at 1, 2, 6, 12 and 24 h after the start of PCA.

Results: The mean time to extubation at the end of anaesthesia and recovery time were similar in both groups. There were no significant differences between groups with regard to mean pain, discomfort, sedation and nausea scores. Cumulative morphine consumption was significantly lower in the dexmedetomidine group at 6, 12 and 24 h (P < 0.05). The incidence of side-effects did not differ between the groups.

Conclusions: A single i.v. dose of dexmedetomidine (1 μg kg−1) given 10 min before induction of anaesthesia significantly reduced postoperative morphine consumption at identical pain scores compared to control, but had no effect on postoperative recovery time.

Keywords

ADRENERGIC α-AGONISTS, dexmedetomidinePAIN, acute, postoperativeANALGESIA, PATIENT-CONTROLLEDMORPHINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 5 , May 2005 , pp. 386 - 391
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Shelly MP. Dexmedetomidine: a real innovation or more of the same. Br J Anaesth 2001; 87: 678–679.Google Scholar
Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004; 98: 153–158.Google Scholar
Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care 2000; 4: 302–308.Google Scholar
Venn RM, Karol MD, Grounds RM. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care. Br J Anaesth 2002; 88: 669–675.Google Scholar
Jaakola ML, Salonen M, Lehtinen R, Scheinin H. The analgesic action of dexmedetomidine – a novel α2 adrenoceptor agonist – in healthy volunteers. Pain 1991; 46: 281–285.Google Scholar
Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54: 1136–1142.Google Scholar
Aho MS, Erkola OA, Scheinin H, et al. Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation. Anesth Analg 1991; 73: 112–118.Google Scholar
Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95: 461–466.Google Scholar
Hayashi Y, Guo TZ, Maze M. Hypnotic and analgesic effects of the alpha 2-adrenergic agonist dexmedetomidine in morphine-tolerant rats. Anesth Analg 1996; 83: 606–610.Google Scholar
Ossipov MH, Suarez LJ, Spaulding TC. Antinociceptive interactions between alpha 2-adrenergic and opiate agonists at the spinal level in rodents. Anesth Analg 1989; 68: 194–200.Google Scholar
Horvath GY, Szikszay M, Benedek GY. Potentiated hypnotic action with a combination of fentanyl, a calcium channel blocker and an α2 agonist in rats. Acta Anaesthesiol Scand 1992; 36: 170–174.Google Scholar
Viggiano M, Badetti C, Roux F, et al. Controlled analgesia in a burn patient: fentanyl sparing effect of clonidine. Ann Fr Anesth Reanim 1998; 17: 19–26.Google Scholar
Lawrence CJ, De Lange S. Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia 1997; 52: 736–744.Google Scholar
Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth 1992; 68: 126–131.Google Scholar
Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the observer's assessment of alertness/sedation (OAA/S) scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244–251.Google Scholar
Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists: their pharmacology and therapeutic role. Anaesthesia 1999; 54: 146–165.Google Scholar
Spaulding TC, Fielding S, Venafro JJ, Lal H. Antinociceptive activity of clonidine and its potentiation of morphine analgesia. Eur J Pharmacol 1979; 58: 19–25.Google Scholar
Puke MJ, Wiesenfeld-Hallin Z. The differential effects of morphine and the alpha 2-adrenoceptor agonists clonidine and dexmedetomidine on the prevention and treatment of experimental neuropathic pain. Anesth Analg 1993; 77: 104–109.Google Scholar
Ylisela E, Vainio O. Effects of medetomidine on the experimental auricular pain in dogs. Acta Vet Scand Suppl 1989; 85: 187–191.Google Scholar
Hall JE, Uhrich TD, Barney JA, et al. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 2000; 90: 699–705.Google Scholar
Karhuvaara S, Kallio A, Salonen M, et al. Rapid reversal of alpha 2-adrenoceptor agonist effects by atipamezole in human volunteers. Br J Clin Pharmacol 1991; 31: 160–165.Google Scholar
Wikberg J. Localization of adrenergic receptors in guinea pig ileum and rabbit jejunum to cholinergic neurons and to smooth muscle cells. Acta Physiol Scand 1977; 99: 190–207.Google Scholar