Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy intravenous analgesia:a randomized, controlled clinical study

Abstract

Background: Few studies have investigated the use of dexmedetomidine in patient-controlled intravenous analgesia (PCIA) after thoracic surgery. This study to evaluate the effect of dexmedetomidine combined with sufentanil for PCIA after thoracotomy under general anaesthesia.

Methods: Ninety-seven adults patients scheduled for thoracotomy surgery. All two groups received PCIA with either sufentanil alone (control group) or combining dexmedetomidine with sufentanil (dexmedetomidine group). Hemodynamic measurements, visual analog scale (VAS) scores at rest and at coughing, Ramsay sedation score (RSS), analgesic consumption, and postoperative nausea and vomiting (PONV) as well as drug-related adverse effects were compared at 2, 6, 12, 24, 36 and 48 h postoperatively.

Results: In the patients of the dexmedetomidine group, compared to the control group, the pain scores at rest or at coughing during 48 h postoperatively were lower (P < 0.001), the sedation scores were lower, the consumption of sufentanil and rescue meperidine were lower, and the number of episode of moderate PONV was three times lower. No signs of toxicity or local complications were observed. There was a non-significant trend for a lower HR and BP in the dexmedetomidine group vs.

Conclusion: The combining dexmedetomidine with sufentanil for post-thoracotomy PCIA can improve pain control together with the decrease in sufentanil requirements, and improve postoperative patient's satisfaction compared with sufentanil alone in PCIA.

Trial registration: This trial was retrospectively registered on 27 April 2016 at the Chinese Clinical Trial Register (number: ChiCTR-ONC-16008376 ).

Keywords: Combination; Dexmedetomidine; Intravenous analgesia; Post-thoracotomy; Sufentanil.

Fig. 1

Patients enrollment flow diagram. PCIA: patient-controlled intravenous analgesia

Fig. 2

Postoperative visual analogue scale (VAS) pain scores. Evaluation of pain score on VASR (a) and VASC (b) (Values represent means with 95% confidence interval) in the two groups. P < 0.001 by General Linear Model analysis, subsequent comparison between the groups: asterisk = P < 0.023 in VASR and P < 0.02 in VASC after the post hoc analyses, dexmedetomidine group vs. control group

Fig. 3

Postoperative Ramsay sedation scale (RSS). (a) restlessness scores and PONV scores. (b) Evaluation of RSS and PONV scores (Values represent mean with 95% confidence interval) in the two groups. P < 0.001 by General Linear Model analysis, subsequent comparison between the groups: asterisk = P < 0.05 after the post hoc analyses, dexmedetomidine group vs. control group. PONV, postoperative nausea and vomiting

Fig. 4

Cumulative PCIA sufentanil consumption and supplementary meperidine doses. (a) There is significantly differences in cumulative PCIA sufentanil consumption at 48 h between in the control group and the dexmedetomidine group (Values represent means with 95% confidence interval, cumulative dose at 48 h for 196.6 ± 22.2 vs. 154.3 ± 17.5 μg, P = 0.034). Sufentanil consumption in the dexmedetomidine group was required 22% less than the control group. (b) Cumulative of meperidine supplementary doses at each time intervals after surgery was significantly lesser in the dexmedetomidine gourp than the control group (P = 0.002). PCIA, patient-controlled intravenous analgesia; SD, standard deviation

Fig. 5

Postoperative hemodynamic variables was assessed at 2, 6, 12, 24, 36 and 48 h postoperatively (Values represent means with 95% confidence interval). Although the heart rate (a), systolic pressure and diastolic pressure (b) were compared between the groups postoperatively. asterisk = P < 0.05 by the post hoc analyses after a General Linear Model, dexmedetomidine group vs. control group

Fig. 6

Patients’ overall postoperative satisfaction rating with 48 h (control group vs dexmedetomidine group). The satisfaction score was assessed using a 4-point scale (not satisfied, moderately satisfied, satisfied, very satisfied). The four categories (N = 180, Mean Rank was 146.3 vs 214.7, x ² = 41.8, df = 1, P = 0.000)