Effects of dexmedetomidine on postoperative pain, perioperative opioid consumption and hemodynamics in supratentorial craniotomies: Observational study

Abstract

Objective: The present study aimed to observe the effects of two different doses of dexmedetomidine infusion in supratentorial craniotomies on intraoperative hemodynamics, inhaled anesthetic, and perioperative opioid consumption. The study also examines whether the method reduces adverse events such as postoperative pain and nausea/vomiting. Methods: Ninety patients aged between 18 and 70 classified as American Society of Anesthesiologists class I–II who underwent supratentorial craniotomy under elective conditions and who received dexmedetomidine infusion (0.2 and 0.4 μg.kg−1h−1 ) or not were observed. Intraoperative hemodynamic data, remifentanil and sevoflurane consumption, postoperative pain and nausea/vomiting scores, and total opioid consumption were evaluated. Results: Hemodynamic data of the patients were similar. Sevoflurane consumption intraoperatively and opioid consumption both intraoperatively and postoperatively decreased significantly in the patients receiving dexmedetomidine infusion (p < 0.001). The pain and nausea/vomiting scores were similar in the postoperative period. Conclusion: Dexmedetomidine infusion during general anesthesia for supratentorial craniotomies reduces inhaled anesthetic and perioperative opioid consumption without causing any hemodynamic side effects.

Keywords

• Neuroanesthesia
• dexmedetomidine
• perioperative care
• postoperative analgesia
• postoperative nausea and vomiting

Supratentorial kraniotomilerde deksmedetomidinin postoperatif ağrı, perioperatif opioid tüketimi ve hemodinami üzerine etkileri: Gözlemsel çalışma

Abstract

Amaç: Bu çalışma, supratentoryal kraniotomi operasyonlarında uygulanan iki farklı dozda deksmedetomidin infüzyonunun intraoperatif hemodinami, inhalasyon anesteziği ve perioperatif opioid tüketimi üzerindeki etkilerini gözlemlemeyi amaçlamıştır. Ayrıca yöntemin postoperatif ağrı ve bulantı/kusma gibi istenmeyen olayları azaltıp azaltmadığı da değerlendirilmiştir. Yöntemler: Elektif koşullarda supratentoryal kraniotomi uygulanan, Amerikan Anesteziyologlar Derneği (ASA) sınıf I–II olarak değerlendirilen 18–70 yaş arası toplam 90 hasta incelenmiştir. Hastalar, deksmedetomidin infüzyonu alan (0.2 ve 0.4 μg·kg⁻¹·saat⁻¹) ve almayan gruplar olarak gözlemlenmiştir. İntraoperatif hemodinamik veriler, remifentanil ve sevofluran tüketimi, postoperatif ağrı ve bulantı/kusma skorları ile toplam opioid tüketimi değerlendirilmiştir. Bulgular: Hastaların hemodinamik verileri benzer bulunmuştur. Deksmedetomidin infüzyonu uygulanan hastalarda intraoperatif sevofluran tüketimi ile intraoperatif ve postoperatif opioid tüketimi anlamlı olarak azalmıştır (p < 0.001). Postoperatif dönemde ağrı ve bulantı/kusma skorları bakımından gruplar arasında anlamlı fark saptanmamıştır. Sonuç: Supratentoryal kraniotomilerde genel anestezi sırasında uygulanan deksmedetomidin infüzyonu, herhangi bir hemodinamik yan etki oluşturmaksızın inhalasyon anesteziği ve perioperatif opioid tüketimini azaltmaktadır.

Keywords

• Nöroanestezi
• deksmedetomidin
• perioperatif bakım
• postoperatif analjezi
• postoperatif bulantı ve kusma.

References

1. 1.Dilmen OK, Akcil EF, Tunali Y, et al. Postoperativeanalgesia for supratentorial craniotomy, Clin.Neurol. Neurosurg. 2016;146:90–95.
2. 2.White PF. Multimodal analgesia: its role inpreventing postoperative pain,Curr. Opin. Investig.Drugs 2008;9:76–82.
3. 3.Hendrickx JFA, Nielsen OJ, De Hert S, De Wolf AM.The science behind banning desflurane: A narrativereview. Eur J Anaesthesiol. 2022;39(10):818-824.
4. 4.Jellish WS, Leonetti JP, Sawicki K, Anderson D,Origitano TC. Morphine/ondansetron PCA forpostoperative pain, nausea, and vomiting after skullbase surgery. Otolaryngol Head Neck Surg.2006;135(2):175-81.
5. 5.Morad AH, Winters BD, Yaster M, et al. Efficacy ofintravenous patient-controlled analgesia aftersupratentorial intracranial surgery: a prospectiverandomized controlled trial. Clinical article. JNeurosurg. 2009;111(2):343-50.
6. 6.Liu Y, Liang F, Liu X, et al. Dexmedetomidinereduces perioperative opioid consumption andpostoperative pain intensity in neurosurgery: ameta-analysis. J Neurosurg Anesthesiol2018;30:146–55.
7. 7.Wenjie W, Houqing L, Gengyun S. Effects ofdexmedetomidine on outcomes followingcraniocerebral operation - a meta-analysis. ClinNeurol Neurosurg 2014;125:194–7.
8. 8.Bekker A, Sturaitis M, Bloom M, et al. The effect ofdexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg. 2008;107(4):1340-7.

9. 9.Tanskanen PE, Kyttä JV, Randell TT, Aantaa RE.Dexmedetomidine as an anaesthetic adjuvant inpatients undergoing intracranial tumour surgery: adouble-blind, randomized and placebo-controlledstudy. Br J Anaesth. 2006;97(5):658-65.
10. 10.Soliman RN, Hassan AR, Rashwan AM, Omar AM.Prospective, randomized study to assess the role ofdexmedetomidine in patients with supratentorialtumors undergoing craniotomy under generalanaesthesia. Middle East J Anaesthesiol.2011;21(3):325-34
11. 11.Jadhav N, Wasekar N, Wagaskar V, Kondwilkar B,Patil R. Use of dexmedetomidine in patientsundergoing craniotomies. Journal of Clinical andDiagnostic Research 2017;11:UC01–8.
12. 12.Aho M, Erkola O, Kallio A, Scheinin H, Korttila K.Dexmedetomidine Infusion for Maintenance ofAnesthesia in Patients Undergoing AbdominalHysterectomy. Anesth Analg 1992;75:940–6.
13. 13.Aantaa R, Jaakola ML, Kallio A, Kanto J. Reductionof the minimum alveolar concentration of isofluraneby dexmedetomidine. Anesthesiology 1997;86:1055–60.
14. 14.Ghodki P, Thombre S, Sardesai S, Harnagle K.Dexmedetomidine as an anesthetic adjuvant inlaparoscopic surgery: An observational study usingentropy monitoring. J Anaesthesiol Clin Pharmacol2012;28:334–8.
15. 15.Mariappan R, Ashokkumar H, Kuppuswamy B.Comparing the Effects of Oral ClonidinePremedication With Intraoperative Dexmedetomidine Infusion on AnestheticRequirement and Recovery From Anesthesia inPatients Undergoing Major Spine Surgery. JNeurosurg Anesthesiol 2013;26:192–7.
16. 16.Gopalakrishna KN, Dash PK, Chatterjee N,Easwer H V, Ganesamoorthi A. Dexmedetomidine asan Anesthetic Adjuvant in Patients Undergoing Transsphenoidal Resection of Pituitary Tumor. J Neurosurg Anesthesiol 2015;27:209–15.
17. 17.Salimi A, Sharifi G, Bahrani H, et al.Dexmedetomidine could enhance surgicalsatisfaction in Trans-sphenoidal resection ofpituitary adenoma. J Neurosurg Sci 2014;61:46–52.
18. 18.Naik BI, Nemergut EC, Kazemi A, et al. The Effectof Dexmedetomidine on Postoperative OpioidConsumption and Pain after Major Spine Surgery.Anesth Analg 2016;122:1646–53.
19. 19.Sriganesh K, Syeda S, Shanthanna H,Venkataramaiah S, Palaniswamy SR. Comparison ofintraoperative fentanyl with dexmedetomidine forperioperative analgesia and opioid consumptionduring craniotomies: A randomised controlled pilotstudy with non-inferiority design. Int J Clin Pract2019;73.
20. 20.Yun Y, Wang J, Tang RR, et al. Effects of anintraoperative dexmedetomidine bolus on thepostoperative blood pressure and pain subsequentto craniotomy for supratentorial tumors. JNeurosurg Anesthesiol 2017;29:211–8.
21. 21.Song J, Ji Q, Sun Q, et al. The Opioid-sparing Effectof Intraoperative Dexmedetomidine Infusion AfterCraniotomy. J Neurosurg Anesthesiol 2016;28:14-20.
22. 22. Bakhamees HS, El-Halafawy YM, El-Kerdawy HM,Gouda NM, Altemyatt S. Effects of dexmedetomidinein morbidly obese patients undergoing laparoscopicgastric bypass. Middle East J Anaesthesiol2007;19:537–51.
23. 23.Peng K, Jin XH, Liu SL, Ji FH. Effect ofIntraoperative Dexmedetomidine on Post-Craniotomy Pain. Clin Ther 2015;37:1114-21.
24. 24.Liang X, Zhou M, Feng J-J, et al. Efficacy ofdexmedetomidine on postoperative nausea andvomiting: a meta-analysis of randomized controlledtrials. Int J Clin Exp Med 2015;8:8450–71.