Department of Pain, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
Department of Pediatric Orthopedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
Curr Drug Metab. 2022;23(1):57-65. doi: 10.2174/1389200222666211118115347.
This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures.
One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery.
The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001).
Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioidcentric towards improved postoperative cognitive dysfunction.
本研究旨在探讨右美托咪定（DEX）对改善疼痛和残疾程度的有效性，以发现心理因素与股骨颈骨折患者疼痛管理满意度和身体功能之间的可能相关性。
前瞻性纳入 124 例接受内固定治疗的成人稳定型股骨颈骨折患者（I 型和 II 型，Garden 分类），包括 DEX 组 62 例和对照组 62 例。术后第 1 天和第 2 天记录髋关节功能 Harris 评分、术后认知功能障碍（MMSE 评分）、术后恢复质量（QoR-40）、疼痛相关焦虑（PASS-20）、疼痛管理和疼痛灾难化量表（PCS）。
DEX 组术后第 1 天和第 2 天的恢复质量评分更高，疼痛管理满意度更高，残疾评分更低，灾难性思维更少，疼痛焦虑更低，简易精神状态检查（MMSE）评分更高，阿片类药物用量更少，与对照组相比差异有统计学意义（P<0.001）。DEX 组出现躁动和术后认知功能障碍的发生率明显低于对照组（P<0.001）。残疾程度降低与灾难性思维减少和疼痛焦虑降低有关，但与阿片类药物用量增加无关（P<0.001）。较高的 QoR-40 评分与更多的灾难性思维和更多的阿片类药物使用呈负相关（P<0.001）。疼痛管理满意度与更少的灾难性思维和更少的阿片类药物使用呈正相关（P<0.001）。
DEX 作为麻醉的辅助用药可显著改善术后认知功能障碍和恢复质量，改善疼痛、DEX 给药引起的躁动和阿片类药物的使用。由于疼痛缓解和残疾程度降低与患者阿片类药物用量增加无关，改善心理因素，包括减少灾难性思维或对疼痛的自我效能感，可能是减少疼痛和残疾、同时减少患者阿片类药物处方的更有效策略。我们的研究结果表明，DEX 给药是一种安全的镇静剂，具有抗炎、镇痛和止吐作用，它可以帮助改变疼痛管理策略，从以阿片类药物为中心转向改善术后认知功能障碍。
