Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
J Arthroplasty. 2019 Apr;34(4):686-692.e2. doi: 10.1016/j.arth.2018.12.036. Epub 2019 Jan 7.
Patients undergoing total hip arthroplasty (THA) need substantial amount of opioids for postoperative pain management, which necessitates opioid-sparing modalities. Dexmedetomidine is a novel alpha-2-adrenoceptor-activating drug for procedural sedation. In addition to its sedative effect, dexmedetomidine has analgesic and antiemetic effects. We evaluated retrospectively the effect of intraoperatively administered intranasal low-dose dexmedetomidine on postoperative opioid requirement in patients undergoing THA.
We included 120 patients with American Society of Anesthesiologists status 1-2, age between 35 and 80 years, and scheduled for unilateral primary THA under general anesthesia with total intravenous anesthesia. Half of the patients received 50 μg of intranasal dexmedetomidine after anesthesia induction, while the rest were treated conventionally. Postoperative opioid requirements were calculated as morphine equivalent doses for both groups. The impact of intranasal dexmedetomidine on postoperative hemodynamics and length of stay was evaluated.
The cumulative postoperative opioid requirement was significantly reduced in the dexmedetomidine group compared with the control group (26.3 mg, 95% confidence interval 15.6-36.4, P < .001). The cumulative dose was significantly different between the groups already at 12, 24, and 36 h postoperatively (P = .01; P = .001; P < .001, respectively). Dexmedetomidine group had lower mean arterial pressure in the postanesthesia care unit compared with the control group (P = .01). There was no difference in the postanesthesia care unit stay or postoperative length of stay between the two groups (P = .47; P = .10, respectively).
Compared with the control group, intraoperative use of intranasal low-dose dexmedetomidine decreases opioid consumption and sympathetic response during acute postoperative period in patients undergoing THA.
接受全髋关节置换术（THA）的患者需要大量阿片类药物来进行术后疼痛管理，这就需要采用阿片类药物节约方法。右美托咪定是一种新型的α-2-肾上腺素能受体激动剂，用于程序性镇静。除了镇静作用外，右美托咪定还有镇痛和止吐作用。我们回顾性评估了术中给予鼻内低剂量右美托咪定对接受 THA 的患者术后阿片类药物需求的影响。
我们纳入了 120 名美国麻醉医师学会（ASA）分级 1-2 级、年龄在 35-80 岁之间、接受全身麻醉下全静脉麻醉的单侧初次 THA 的患者。一半患者在麻醉诱导后接受 50μg 鼻内右美托咪定，其余患者接受常规治疗。两组患者术后阿片类药物的需求量均以吗啡等效剂量计算。评估了鼻内右美托咪定对术后血流动力学和住院时间的影响。
与对照组相比，右美托咪定组术后累积阿片类药物需求量显著减少（26.3mg，95%置信区间 15.6-36.4，P<0.001）。两组在术后 12、24 和 36 小时的累积剂量均有显著差异（P=0.01；P=0.001；P<0.001）。与对照组相比，右美托咪定组在麻醉后护理单元的平均动脉压较低（P=0.01）。两组患者在麻醉后护理单元停留时间或术后住院时间无差异（P=0.47；P=0.10）。
与对照组相比，THA 患者术中使用鼻内低剂量右美托咪定可减少术后急性疼痛期的阿片类药物消耗和交感神经反应。
