The use of dexmedetomidine for the multimodal low-opioid anesthesia during laparoscopic renal surgery

Authors

  • T.V. Ovsiienko Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine; State Institution “Academician O.F. Vozianov Institute of Urology” of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.18.2.2022.1476

Keywords:

multimodal low-opioid anesthesia, surgical stress, antinociceptive protection, laparoscopic surgery

Abstract

Background. Dexmedetomidine, a highly selective α2-adrenergic agonist, has become a valuable component of low-opioid multimodal anesthesia, providing sedative, anxiolytic, and analgesic effects. These features make it a useful addition to the anesthesia protocol, especially in the context of providing adequate antinociceptive protection, anti-stress effect, hemodynamic stabilization and prevention of postoperative delirium. Our work was aimed to evaluate the effectiveness of dexmedetomidine for a multimodal low-opioid anesthesia program for laparoscopic renal surgery by comparing the effectiveness with general anesthesia, where traditional doses of opiates were used to provide an antinociceptive effect. Materials and methods. Fifty-five patients who underwent laparoscopic renal surgery under two types of general anesthesia were included. All patients underwent surgery under general anes­thesia with tracheal intubation. Induction: intravenous propofol 2 mg/kg, fentanyl 1.5–2 μg/kg, atracurium 0.6 mg/kg. Anesthesia maintenance: sevoflurane (MAC — 1.44 ± 0.25 vol. %). In group 1 (control group of 26 patients), analgesia was provided with fentanyl 3.89 ± 2.10 μg/kg/h. Multimodal low-opioid anesthesia with fentanyl at a dose of 2.38 ± 1.01 μg/kg/h combined with dexmedetomidine 0.7 μg/kg/h was used in group 2 (29 patients). The efficacy of antinociceptive protection was assessed by the dynamics of the levels of stress hormones, hemodynamic parameters, and blood glucose concentrations. Results. The total average doses of fentanyl used during the entire period of anesthesia were 369.23 ± 16.42 μg in group 1, 272.41 ± 10,98 μg in group 2 (p < 0.001). In patients of the control group, an increase in the plasma concentration of adrenocorticotropic hormone by 111.86 % (p < 0.01) from 25.7 ± 2.1 to 54.45 ± 5.43 pg/ml was recorded (the study was conducted before the start of surgery and after the end of the operation), which was accompanied by a statistically significant increase in cortisol concentration from 371.00 ± 32.32 to 562.72 ± 45.37 nmol/l (by 51.67 %) (p < 0.01). In patients of group 2 (dexmedetomidine group), an intraoperative increase in the plasma concentration of adrenocorticotropic hormone was recorded from 26.25 ± 2.30 to 46.88 ± 2.36 pg/l (by 78.59 %) (p < 0.01), which was accompanied by a statistically insignificant intraoperative increase in cortisol concentration from 393.51 ± 25.00 to 436.37 ± 34.92 nmol/l — only by 10.89 % (p > 0.05). Blood glucose concentrations in the early postoperative period in the study groups were 6.79 ± 0.31 and 6.29 ± 0.24 mmol/l, respectively (p > 0.05). Hemodynamic para­meters and BIS, which was maintained within 44.0 ± 6.4 %, indicated the adequacy of anesthesia and analgesia in all study groups. The indicators of the functional state of the kidneys were within the normal range in all patients. In group 1, in the p/o period 8 patients out of 26 (30.7 %) required additional analgesia with opioids (the level of pain on the VAS scale exceeded 4 points). In group 2, four patients (13.8 %) required opioid analgesia. In group 1, vomiting in the postoperative period occurred in 5 patients, in group 2 — in 3 patients. The standardized rate of postoperative nausea and vomi­ting in the control group was 19.2 %, in group 2 — 10.3 %. Conclusions. The use of dexmedetomidine for multimodal low-opioid anesthesia in laparoscopic renal surgery provides the greatest antinociceptive protection and reduces the stress response to surgery.

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References

Buvanendran A., Kroin J.S. Multimodal analgesia for controlling acute postoperative pain. Curr. Opin. Anaesthesiol. 2009. 22(5). 588-593. doi: 10.1097/ACO.0b013e328330373a.

Helander E.М. et al. Multimodal Approaches to Analgesia in Enhanced Recovery After Surgery Pathways. Int. Anesthesiol. Clin. 2017. 55(4). 51-69. doi: 10.1097/AIA.0000000000000165.

Paris A., Tonner P.H. Dexmedetomidine in anaesthesia. Curr. Opin. Anaesthesiol. 2005. 18(4). 412-418. doi: 10.1097/01.aco.0000174958.05383.d5.

Rajan S. et al. The Effects of Dexmedetomidine and Remifen­tanil on Hemodynamic Stability and Analgesic Requirement After Craniotomy: A Randomized Controlled Trial. J. Neurosurg. Anesthesiol. 2016. 28(4). 282-290. doi: 10.1097/ANA.0000000000000221.

Naik B.І. et al. The Effect of Dexmedetomidine on Postoperative Opioid Consumption and Pain After Major Spine Surgery. Anesth. Analg. 2016. 122(5). 1646-1653. doi: 10.1213/ANE.0000000000001226.

Hwang W., Lee J., Park J., Joo J. Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: a randomized controlled study. BMC Anesthesiol. 2015. 15. 21. Published 2015 Feb 24. doi: 10.1186/s12871-015-0004-1.

Grewal A. Dexmedetomidine: New avenues. J. Anaesthesiol. Clin. Pharmacol. 2011. 27(3). 297-302. doi: 10.4103/0970-9185.83670.

Naaz S., Ozair E. Dexmedetomidine in current anaesthesia practice — a review. J. Clin. Diagn. Res. 2014. 8(10). GE01-GE4. doi: 10.7860/JCDR/2014/9624.4946.

Bellon M. et al. Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies. Pain Ther. 2016. 5(1). 63-80. doi: 10.1007/s40122-016-0045-2.

Blaudszun G., Lysakowski C., Elia N., Tramèr M.R. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012. 116(6). 1312-1322. doi: 10.1097/ALN.0b013e31825681cb.

Le Bot A., Michelet D., Hilly J. et al. Efficacy of intraoperative dexmedetomidine compared with placebo for surgery in adults: a meta-analysis of published studies. Minerva Anestesiol. 2015. 81(10). 1105-1117.

Singh P.М. et al. Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis. Surg. Obes. Relat. Dis. 2017. 13(8). 1434-1446. doi: 10.1016/j.soard.2017.02.025.

Wang X., Liu N., Chen J., Xu Z., Wang F., Ding C. Effect of intravenous dexmedetomidine during general anesthesia on acute postoperative pain in adults. The Clinical journal of pain. 2018. 34(12). 1180-1191.

Unlugenc H., Gunduz M., Guler T., Yagmur O., Isik G. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur. J. Anaesthesiol. 2005. 22(5). 386-391. doi: 10.1017/s0265021505000669.

Gurbet A., Basagan-Mogol E., Turker G., Ugun F., Kaya F.N., Ozcan B. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can. J. Anaesth. 2006. 53(7). 646-652. doi: 10.1007/BF03021622.

Xu S.Q. et al. Effects of intravenous lidocaine, dexmedetomidine and their combination on postoperative pain and bowel function recovery after abdominal hysterectomy. Minerva Anestesiol. 2017. 83(7). 685-694. doi: 10.23736/S0375-9393.16.11472-5.

Fan W. et al. Comparison of the pro-postoperative analgesia of intraoperative dexmedetomidine with and without loading dose following general anesthesia: a prospective, randomized, controlled clinical trial. Medicine. 2017. 96(7).

Feng M. et al. Dexmedetomidine and sufentanil combination versus sufentanil alone for postoperative intravenous patient-controlled analgesia: a systematic review and meta-analysis of randomi­zed controlled trials. BMC Anesthesiol. 2019. 19(1). 81. Published 2019 May 18. doi:10.1186/s12871-019-0756-0.

Peng K. et al. Optimization of Postoperative Intravenous Patient-Controlled Analgesia with Opioid-Dexmedetomidine Combinations: An Updated Meta-Analysis with Trial Sequential Analysis of Randomized Controlled Trials. Pain Physician. 2017. 20(7). 569-596.

Wang X. еt al. Effect of dexmedetomidine alone for intravenous patient-controlled analgesia after gynecological laparoscopic surgery: a consort-prospective, randomized, controlled trial. Medicine. 2016. 95(19).

Lightman S.L., Birnie M.Т., Conway-Campbell B.L. Dynamics of ACTH and Cortisol Secretion and Implications for Di­sease. Endocr. Rev. 2020. 41(3). bnaa002. doi: 10.1210/endrev/bnaa002.

Davis G. et al. Stress hyperglycemia in general surgery: Why should we care? J. Diabetes Complications. 2018. 32(3). 305-309. doi: 10.1016/j.jdiacomp.2017.11.010.

Saadat-Gilani K., Zarbock A., Meersch M. Perioperative Renoprotection: Clinical Implications. Anesth. Analg. 2020. 131(6). 1667-1678. doi: 1213/ANE.0000000000004995.

Prete A. et al. The cortisol stress response induced by surgery: A systematic review and meta-analysis. Clin. Endocrinol. (Oxf). 2018. 89(5). 554-567. doi: 10.1111/cen.13820.

Weerink M.A. et al. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clinical pharmacokinetics. 2017. 56(8). 893-913.

Naaz S., Ozair E. Dexmedetomidine in current anaesthesia practice — a review. J. Clin. Diagn. Res. 2014. 8(10). GE01-GE4. doi: 10.7860/JCDR/2014/9624.4946.

Giovannitti J.А. Jr, Thoms S.М., Crawford J.J. Alpha-2 adrenergic receptor agonists: a review of current clinical applications. Anesth. Prog. 2015 Spring. 62(1). 31-9. doi: 10.2344/0003-3006-62.1.31. PMID: 25849473; PMCID: PMC4389556.

Shariffuddin I.I., Teoh W.H., Waha S., Wang C.Y. Effect of single-dose dexmedetomidine on postoperative recovery after ambulatory ureteroscopy and ureteric stenting: a double blind randomized controlled study. BMC anesthesiology. 2018. 18(1). 1-8.

Panchgar V. et al. The effectiveness of intravenous dexmedetomidine on perioperative hemodynamics, analgesic requirement, and side effects profile in patients undergoing laparoscopic surgery under general anesthesia. Anesthesia, essays and researches. 2017. 11(1). 72.

Hakim K.Y.K., Wahba W.Z.В. Opioid-free total intravenous anesthesia improves postoperative quality of recovery after ambulatory gynecologic laparoscopy. Anesthesia, essays and researches. 2019. 13(2). 199.

Song Y., Shim J.К., Song J.W., Kim E.К., Kwak Y.L. Dexmedetomidine added to an opioid-based analgesic regimen for the prevention of postoperative nausea and vomiting in highly susceptible patients: A randomised controlled trial. Eur. J. Anaesthesiol. 2016. 33(2). 75-83. doi: 10.1097/EJA.0000000000000327.

Davy A., Fessler J., Fischler M., Le Guen M. Dexmedetomidine and general anesthesia: a narrative literature review of its major indications for use in adults undergoing non-cardiac surgery. Minerva Anestesiol. 2017. 83(12). 1294-1308. doi: 10.23736/S0375-9393.17.12040-7.

Published

2022-05-19

How to Cite

Ovsiienko, T. (2022). The use of dexmedetomidine for the multimodal low-opioid anesthesia during laparoscopic renal surgery. EMERGENCY MEDICINE, 18(2), 58–65. https://doi.org/10.22141/2224-0586.18.2.2022.1476

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Section

Original Researches