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For: Uusalo P, Jätinvuori H, Löyttyniemi E, Kosola J, Saari TI. Intranasal Low-Dose Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Hip Arthroplasty Under General Anesthesia. J Arthroplasty 2019;34:686-692.e2. [PMID: 30733071 DOI: 10.1016/j.arth.2018.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/12/2018] [Accepted: 12/28/2018] [Indexed: 02/01/2023] Open

For:	Uusalo P, Jätinvuori H, Löyttyniemi E, Kosola J, Saari TI. Intranasal Low-Dose Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Hip Arthroplasty Under General Anesthesia. J Arthroplasty 2019;34:686-692.e2. [PMID: 30733071 DOI: 10.1016/j.arth.2018.12.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/12/2018] [Accepted: 12/28/2018] [Indexed: 02/01/2023] Open

Number

Cited by Other Article(s)

Wang W, Chen Y, Li G, Chen Y, Wu J, Shi Y, Zhong M. The Opioid-Sparing Effects of Intraoperative Esketamine Combined with Dexmedetomidine During Laparoscopic Major Abdominal Surgery: A Randomized Controlled Double-Blind Trial. Drug Des Devel Ther 2025;19:1971-1981. [PMID: 40110501 PMCID: PMC11920631 DOI: 10.2147/dddt.s480700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 02/13/2025] [Indexed: 03/22/2025] Open

Abstract

Background

Recently, opioid-sparing (OS) interventions have been proposed to facilitate rapid postoperative recovery for patients. However, the advantages of OS anesthesia strategy in laparoscopic abdominal major surgery are still unknown.

Methods

157 patients undergoing laparoscopic major abdominal surgery were randomly assigned to two groups: Remi (77, remifentanil) and OS (80, esketamine combined with dexmedetomidine), the drugs were administered at 0.2-0.5 mg/kg/h (remifentanil or esketamine) and 0.2-0.7μg/kg/h (remifentanil or dexmedetomidine) in two syringes, respectively The primary outcome was the numeric rating scale (NRS) pain score on postoperative day (POD)1. The proportion of rescue analgesia within 48 h, extubation time, postoperative quality recover scale (PQRS), Pittsburgh Sleep Quality Index (PSQI) on POD30 were also recorded.

Results

In the postanaesthesia care unit (PACU), the NRS pain score and the proportion of rescue analgesia in Remi group was significantly higher than that in OS group (3 [1 to 3] vs 1 [1 to 3], P = 0.001; 15.6% vs 5.0%, P = 0.028, respectively), although there were no statistical differences in NRS pain score on POD1, POD7 and POD30 between groups (3 [2 to 3] vs 3 [2 to 3], P = 0.648; 2 [1 to 2] vs 2 [1 to 2], P = 0.418; 0 [1 to 1] vs 0 [1 to 1], P = 0.656, respectively). The extubation time in the OS group was longer and the proportion of dreaminess was also higher than that in the Remi group (20 [11 to 34] vs 31 [21 to 40], P < 0.01; 15.6% vs 42.5%, P < 0.01), However, the PSQI on POD30 were similar between groups (8.27±3.94 vs 8.37±3.89, P = 0.870).

Conclusion

In this study, OS anesthesia strategy during laparoscopic major abdominal surgery decreases the NRS pain scores in PACU and reduces the use of rescue analgesia, though it may prolong the extubation time and increase the proportion of dreaminess during hospitalization.

Trial Registration Number

ChiCTR2200060130.

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Ding X, Shi D, Cai H, Yan Z, Shen G. Intranasal Atomized Dexmedetomidine in Combination With Intranasal Atomized Butorphanol for Dressing Change Sedation and Analgesia in Adult Burn Patients: A Randomized Clinical Trial. J Burn Care Res 2025;46:341-348. [PMID: 39126665 DOI: 10.1093/jbcr/irae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Indexed: 08/12/2024]

Tiainen SM, Heinonen H, Koskinen A, Mäkelä S, Laitio R, Löyttyniemi E, Mäkelä K, Saari TI, Uusalo P. Premedication with intranasal dexmedetomidine in patients undergoing total knee arthroplasty under spinal anaesthesia (TKADEX)-a prospective, double-blinded, randomised controlled trial. BJA OPEN 2025;13:100382. [PMID: 40114985 PMCID: PMC11923756 DOI: 10.1016/j.bjao.2025.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 02/04/2025] [Indexed: 03/22/2025]

Abstract

Background

Previous studies have shown that perioperative use of adjuvants, such as the alpha-2 agonist dexmedetomidine, may reduce postoperative pain and opioid requirements. However, information about optimal dosing is lacking. We investigated if premedication with intranasal dexmedetomidine compared with placebo reduces postoperative pain in patients undergoing total knee arthroplasty under spinal anaesthesia.

Methods

This single-centre, double-blind, two-arm study compared premedication with intranasal dexmedetomidine (single 1 μg kg-1 dose) to intranasal saline in 101 consecutive elective patients undergoing total knee arthroplasty under spinal anaesthesia. The primary outcome was postoperative pain measured with the numerical rating scale during the first 24 h. Secondary outcomes were postoperative opioid requirement, perioperative haemodynamic variables, requirement of additional intraoperative sedation, incidence of postoperative nausea and vomiting, and patient satisfaction at 30 days after surgery.

Results

Patients in the dexmedetomidine group had lower numerical rating scale scores [median (interquartile range) 2.0 (0.0-3.0)] at 3 h when compared with the control group [3.0 (2.0-4.0)] (P=0.037). Cumulative 24 h opioid requirements (in morphine equivalents) did not differ between dexmedetomidine [45 mg (30-68 mg)] and control groups [53 mg (38-88 mg)] (P=0.334). More patients in the dexmedetomidine group were satisfied with pain management in the ward (P=0.0013). The groups did not differ in the incidence of postoperative nausea and vomiting (P=0.310) or haemodynamic adverse events (P>0.27 for all).

Conclusions

Our results indicate that intranasal dexmedetomidine may reduce postoperative pain and the requirement for additional sedation and increase short-term patient satisfaction in patients undergoing total knee arthroplasty.

Clinical trial registration

ClinicalTrials.gov (NCT04859283).

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Tiainen SM, Anderson BJ, Rinne E, Tornio A, Engström MT, Saari TI, Uusalo P. Absorption pharmacokinetics and feasibility of intranasal dexmedetomidine in patients under general anaesthesia. Acta Anaesthesiol Scand 2024;68:1182-1191. [PMID: 38895976 DOI: 10.1111/aas.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]

Abstract

BACKGROUND

The use of intranasal dexmedetomidine is hampered by a limited understanding of its absorption pharmacokinetics.

METHODS

We examined the pharmacokinetics and feasibility of intranasal dexmedetomidine administered in the supine position to adult patients undergoing general anaesthesia. Twenty-eight patients between 35 and 80 years of age, ASA 1-3 and weight between 50 and 100 kg, who underwent elective unilateral total hip or knee arthroplasty under general anaesthesia were recruited. All patients received 100 μg of intranasal dexmedetomidine after anaesthesia induction. Six venous blood samples (at 0, 5, 15, 45, 60, 240 min timepoints from dexmedetomidine administration) were collected from each patient and dexmedetomidine plasma concentrations were measured. Concentration-time profiles after nasal administration were pooled with earlier data from a population analysis of intravenous dexmedetomidine (n = 202) in order to estimate absorption parameters using nonlinear mixed effects. Peak concentration (CMAX) and time (TMAX) were estimated using simulation (n = 1000) with parameter estimates and their associated variability.

RESULTS

There were 28 adult patients with a mean (SD) age of 66 (8) years and weight of 83 (10) kg. The mean weight-adjusted dose of dexmedetomidine was 1.22 (0.15) μg kg-1. CMAX 0.273 μg L-1 was achieved at 98 min after intranasal administration (TMAX). The relative bioavailability of dexmedetomidine was 80% (95% CI 75-91%). The absorption half-time (TABS = 120 min; 95% CI 90-147 min) was slower than that in previous pharmacokinetic studies on adult patients. Perioperative haemodynamics of all patients remained stable.

CONCLUSIONS

Administration of intranasal dexmedetomidine in the supine position during general anaesthesia is feasible with good bioavailability. This administration method has slower absorption when compared to awake patients in upright position, with consequent concentrations attained after TMAX for several hours.

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Wu J, Liu X, Ye C, Hu J, Ma D, Wang E. Intranasal dexmedetomidine improves postoperative sleep quality in older patients with chronic insomnia: a randomized double-blind controlled trial. Front Pharmacol 2023;14:1223746. [PMID: 38034987 PMCID: PMC10687473 DOI: 10.3389/fphar.2023.1223746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open

Abstract

Objective: This study was determined to investigate the impact of intranasal dexmedetomidine (DEX) on postoperative sleep quality in older patients (age over 65) with chronic insomnia during their hospitalization after surgery. Design: A randomized double-blind controlled trial was conducted to compare the effects of intranasal dexmedetomidine spray with a placebo group. Setting and Participants: The study was carried out at Xiangya Hospital, Central South University. 110 participants with chronic insomnia were analyzed. Methods: This trial enrolled older patients who underwent total hip/knee arthroplasty and randomized them to receive intranasal dexmedetomidine (2.0 μg/kg) or saline daily at around 9 p.m. after surgery until discharge. The primary outcomes were subjective sleep quality assessed with the Leeds Sleep Evaluation Questionnaire (LSEQ). The secondary outcomes included the objective sleep quality measured with the Acti-graph, the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI). The other outcomes included the incidence of delirium, levels of inflammatory factors, visual analog scale (VAS) pain scores, postoperative opioid consumption, and treatment-related adverse events. Results: 174 patients were screened for eligibility, and 110 were recruited and analyzed. The DEX group had significantly higher scores on both the LSEQ-Getting to sleep and LSEQ-Quality of Sleep at each time point compared to the placebo (p < 0.0001), The least squares (LS) mean difference in LSEQ-GTS score at T0 between placebo group and DEX group was 2 (95% CI, -1-6), p = 0.4071 and at T5 was -14 (95% CI, -17 to -10), p < 0.0001; The LS mean difference in the LSEQ-QOS score at T0 was -1 (95% CI, -4 to 1), p = 0.4821 and at T5 was -16 (95% CI, -21 to -10), p < 0.0001. The DEX group exhibited significant improvement in Total Sleep Time (TST), Sleep Onset Latency (SOL), and Sleep Efficiency (SE), at each time point after treatment compared to the placebo group (p < 0.0001). The PSQI and ISI scores in the DEX group were reduced after treatment (p < 0.001). No significant adverse events were reported with the use of dexmedetomidine. Conclusion and Implications: This study demonstrates that intranasal administration of dexmedetomidine improves postoperative sleep quality in older patients with chronic insomnia who undergo surgery, without increasing the incidence of adverse effects. Clinical Trial Registration: http://www.chictr.org.cn/, identifier ChiCTR2200057133.

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Holland CT, Meyers AJ, Lum ZC, Tougas H, Giordani M, Meehan JP. Intravenous Dexmedetomidine Use in Total Hip Arthroplasty May Lead to Elevated Rates of Hypotension. Cureus 2023;15:e43768. [PMID: 37727155 PMCID: PMC10506858 DOI: 10.7759/cureus.43768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 09/21/2023] Open

Abstract

Purpose Enhanced recovery protocols for total hip arthroplasty (THA), using opioid-sparing techniques have become widely used. Reports of novel additions to multimodal pain control regimens have been published, however, a paucity of literature exists on the use of intravenous dexmedetomidine. In this study, we analyzed our experience with intravenous dexmedetomidine and hypothesized that it would reduce postoperative opioid use. Secondary outcomes were also examined, including post-operative hypotension, hemoglobin, length of stay, and discharge disposition. Methods All patients who underwent primary THA at a single tertiary-level center between January 1, 2016, and September 1, 2019, underwent investigation. Diagnosis, surgical approach, anesthetic type, body mass index (BMI), and American Society of Anesthesiologists (ASA) score were recorded. Postoperative clinical measures were analyzed, adjusting for patient and surgical characteristics. Results Of the 599 patients included in the study, 218 patients received intravenous (IV) dexmedetomidine, at a mean dose of 44.9 mg during their operative event. Using a multivariate model, patients in the IV dexmedetomidine group were estimated to have received 24% elevated morphine milligram equivalent at postoperative day zero compared to those in the control group (p = 0.05). In addition, patients in the IV dexmedetomidine group who underwent spinal anesthesia had increased odds of hypotension 3.47 times that of the control [odds ratio (OR) 1.43-8.43, p=0.006]. Conclusions Surprisingly, we found no opioid-sparing effects with the use of IV dexmedetomidine. IV dexmedetomidine may be used cautiously as an anesthesia adjunct with spinal anesthesia in the setting of primary THA, as the experience at our institution illustrated increased odds of postoperative hypotension. Level of evidence This retrospective case-control study has a level of evidence III.

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Li JQ, Yuan H, Wang XQ, Yang M. Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery. World J Clin Cases 2023;11:3756-3764. [PMID: 37383121 PMCID: PMC10294164 DOI: 10.12998/wjcc.v11.i16.3756] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open

Abstract

BACKGROUND

A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact, general anesthesia can easily induce complications such as cognitive dysfunction, which is not conducive to postoperative recovery.

AIM

To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement surgery.

METHODS

A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group (49 cases) and observation group (49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after operation. The postoperative recovery and adverse events of the two groups were statistically analyzed.

RESULTS

Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h (P < 0.05); the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation (P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation (P < 0.05). The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1β and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operation than those before operation (P < 0.05). The level of serum urea nitrogen in the two groups was higher than that before operation, and that in the observation group was lower than that in the control group (P < 0.05). During hospitalization, the first time of getting out of bed, recovery time of grade II muscle strength, recovery time of grade III muscle strength and hospitalization time in the observation group were shorter than those in the control group (P < 0.05).

CONCLUSION

Dexmedetomidine can effectively improve the vital signs of elderly patients undergoing hip replacement surgery, reduce the body's inflammatory response and renal function damage, and promote postoperative recovery. Meanwhile, dexmedetomidine showcased a good safety profile and a good anesthetic outcome.

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Sun H, Ma X, Wang S, Li Z, Lu Y, Zhu H. Low-dose intranasal dexmedetomidine premedication improves epidural labor analgesia onset and reduces procedural pain on epidural puncture: a prospective randomized double-blind clinical study. BMC Anesthesiol 2023;23:185. [PMID: 37254106 DOI: 10.1186/s12871-023-02146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open

Abstract

BACKGROUND

Epidural labor analgesia is a safe and effective method of pain management during labor with the drawbacks of delayed onset and maternal distress during epidural puncture. This study aimed to determine whether pretreatment with intranasal low-dose dexmedetomidine effectively shortens the onset of analgesia and reduces procedural pain.

METHODS

In this prospective, randomized double-blind trial, nulliparous patients were randomly assigned to either the intranasal dexmedetomidine group or the control group. The intranasal dexmedetomidine group received 0.5 μg/kg dexmedetomidine intranasally, and the control group received an equal volume of normal saline intranasally. Both groups were maintained with a programmed intermittent epidural bolus. The primary outcome was the onset time of analgesia and scores of pain related to the epidural puncture.

RESULTS

Seventy-nine patients were enrolled, and 60 completed the study and were included in the analysis. The time to achieve adequate analgesia was significantly shorter in the intranasal dexmedetomidine group than in the control group (hazard ratio = 2.069; 95% CI, 2.187 to 3.606; P = 0.010). The visual analogue scale pain scores during epidural puncture in the intranasal dexmedetomidine group were also significantly lower than those in the control group (2.0 (1.8-2.5) vs. 3.5 (3.3-4.5), P ≤ 0.001, Table 2). Pretreatment with intranasal dexmedetomidine before epidural labor analgesia was associated with improved visual analogue scale pain scores and Ramsay scores, less consumption of analgesics and higher maternal satisfaction (P < 0.05). No differences were observed for labor and neonatal outcomes or the incidence of adverse effects between the two groups.

CONCLUSIONS

Pretreatment with intranasal dexmedetomidine before epidural labor analgesia yielded a faster onset of analgesia and decreased epidural puncture pain without increasing adverse effects. Pretreatment with intranasal dexmedetomidine may be a useful adjunct for the initiation of epidural analgesia, and further investigation should be encouraged to determine its utility more fully.

TRIAL REGISTRATION

This trial was prospectively registered at Chictr.org.cn on 29/05/2020 with the registration number ChiCTR2000033356 ( http://www.chictr.org.cn/listbycreater.aspx ).

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Dieudonné Rahm N, Zaccaria I, Gil Wey B, Pautex S, Habre W, Elia N. Intranasal Dexmedetomidine for Pain Management in Older Patients: A Cross-Over, Randomized, Double-Blinded, Active-Controlled Trial. Drugs Aging 2023;40:527-538. [PMID: 37170043 PMCID: PMC10174599 DOI: 10.1007/s40266-023-01027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/13/2023]

Kuang Y, Wang SY, Wang MN, Yang GP, Guo C, Yang S, Zhang XF, Yang XY, Pei Q, Zou C, He YH, Zhou YY, Duan KM, Huang J. Safety, Pharmacokinetics/Pharmacodynamics, and Absolute Bioavailability of Dexmedetomidine Hydrochloride Nasal Spray in Healthy Subjects: A Randomized, Parallel, Escalating Dose Study. Front Pharmacol 2022;13:871492. [PMID: 35668951 PMCID: PMC9163677 DOI: 10.3389/fphar.2022.871492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open

Affiliation(s)

Yun Kuang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Sai-Ying Wang Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
Meng-Na Wang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Guo-Ping Yang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China Research Center of Drug Clinical Evaluation of Central South University, Changsha, China Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
Can Guo Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Shuang Yang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Xing-Fei Zhang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Xiao-Yan Yang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China
Qi Pei Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
Chan Zou Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China Research Center of Drug Clinical Evaluation of Central South University, Changsha, China
Yan-Hong He Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
Ying-Yong Zhou Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
Kai-Ming Duan Department of Anesthesiology, Third Xiangya Hospital of Central South University, Changsha, China
Jie Huang Center for Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China Research Center of Drug Clinical Evaluation of Central South University, Changsha, China *Correspondence: Kai-Ming Duan, ; Jie Huang,

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Wilson SH, Wilson PR, Bridges KH, Bell LH, Clark CA. Nonopioid Analgesics for the Perioperative Geriatric Patient: A Narrative Review. Anesth Analg 2022;135:290-306. [PMID: 35202007 DOI: 10.1213/ane.0000000000005944] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Karam JA, Schwenk ES, Parvizi J. An Update on Multimodal Pain Management After Total Joint Arthroplasty. J Bone Joint Surg Am 2021;103:1652-1662. [PMID: 34232932 DOI: 10.2106/jbjs.19.01423] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Uusalo P, Seppänen SM, Järvisalo MJ. Feasibility of Intranasal Dexmedetomidine in Treatment of Postoperative Restlessness, Agitation, and Pain in Geriatric Orthopedic Patients. Drugs Aging 2021;38:441-450. [PMID: 33728561 PMCID: PMC8096763 DOI: 10.1007/s40266-021-00846-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/20/2022]

Abstract

Objective

The aim of this study was to report preliminary data on the use of intranasal dexmedetomidine to treat postoperative restlessness, agitation, and pain in 23 patients aged > 70 years and undergoing orthopedic surgery.

Background

Postoperative agitation and delirium are common among older adult patients undergoing orthopedic surgery. Most preparations used to treat agitation and delirium carry a risk for adverse events such as respiratory failure. Moreover, mere opioid therapy may be insufficient in treatment of pain. Dexmedetomidine, an α2-adrenoreceptor agonist with sedative and analgesic properties, has been shown to reduce opioid requirement and reduce postoperative delirium in older adults.

Methods

We studied the use of post-operative intranasal dexmedetomidine in a retrospective study cohort of geriatric patients undergoing orthopedic surgery. Primary outcomes included alterations in heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO2), Modified Richmond Agitation and Sedation Score (mRASS), and opioid consumption following dexmedetomidine administration.

Results

We identified 23 patients with a mean (SD) age of 79.9 (7.5) years who received dexmedetomidine 100 µg intranasally postoperatively. After dexmedetomidine administration, HR decreased by 10.4 (3.7) beats/min (95% CI 2.9–17.8; p = 0.004) and MAP by 16.2 (4.4) mmHg (95% CI 7.3–25.1; p < 0.001). HR decrease was significant at 2 h and MAP decrease at 1, 2, and 3 h following dexmedetomidine administration. Dexmedetomidine administration was associated with significant reductions in opioid consumption (p < 0.001) and mRASS score (p < 0.001). SpO₂ and RR remained unchanged.

Conclusions

These preliminary findings suggest that intranasal dexmedetomidine reduces opioid consumption without causing respiratory depression and may be used to treat postoperative restlessness, agitation, and pain in geriatric patients. However, hemodynamic effects of dexmedetomidine may require close observation for 3 hours following administration in older adult patients.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40266-021-00846-6.

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Seppänen SM, Kuuskoski R, Mäkelä KT, Saari TI, Uusalo P. Intranasal Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Total Knee Arthroplasty Under General Anesthesia. J Arthroplasty 2021;36:978-985.e1. [PMID: 33046329 DOI: 10.1016/j.arth.2020.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/10/2020] [Accepted: 09/18/2020] [Indexed: 02/02/2023] Open

Abstract

BACKGROUND

Total knee arthroplasty (TKA) causes severe pain, and strong opioids are commonly used in postoperative analgesia. Dexmedetomidine is a novel alpha-2-adrenoceptor-activating drug indicated for procedural sedation, but previous studies have shown clinically relevant analgesic and antiemetic effects. We evaluated retrospectively the effect of intranasal dexmedetomidine on the postoperative opioid requirement in patients undergoing TKA.

METHODS

One hundred and fifty patients with ASA status 1-2, age between 35 and 80 years, and scheduled for unilateral primary TKA under total intravenous anesthesia were included in the study. Half of the patients received 100 μg of intranasal dexmedetomidine after anesthesia induction, while the rest were treated conventionally. The postoperative opioid requirement was calculated as morphine equivalent doses for both groups. The effect of dexmedetomidine on postoperative hemodynamics, length of stay (LOS), and incidence of postoperative nausea and vomiting (PONV), was evaluated.

RESULTS

The cumulative postoperative opioid consumption was significantly reduced in the dexmedetomidine group compared to the control group (-28.5 mg, 95% CI 12-47 mg P < .001). The reduction in cumulative opioid dose was significantly different between the groups already at 2, 12, 24, and 36 h postoperatively (P < .001). LOS was shorter in the dexmedetomidine group (P < .001), and the dexmedetomidine group had lower postoperative mean arterial pressure and heart rates were lower compared to the control group (P < .001). The incidence of PONV did not differ between the groups (P = .64).

CONCLUSION

Intraoperatively administered intranasal dexmedetomidine reduces postoperative opioid consumption and may be associated with a shorter hospital stay in patients undergoing TKA under general anesthesia.

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Poonai N, Spohn J, Vandermeer B, Ali S, Bhatt M, Hendrikx S, Trottier ED, Sabhaney V, Shah A, Joubert G, Hartling L. Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review. Pediatrics 2020;145:peds.2019-1623. [PMID: 31862730 DOI: 10.1542/peds.2019-1623] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open

Li M, Glassman A. What's New in Hip Replacement. J Bone Joint Surg Am 2019;101:1619-1627. [PMID: 31567798 DOI: 10.2106/jbjs.19.00553] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]