Hemavathi U, Sreekanth C, Shetty Akshay, Krishnakumari Aparna Melethu, Jain Shreyans Sanaki, Iyengar Aditya
Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi Dental College and Hospital, Bangalore, 560032 India.
Department of Emergency Medicine, Bangalore Baptist Hospital, Bangalore, 560032 India.
J Maxillofac Oral Surg. 2024 Dec;23(6):1610-1619. doi: 10.1007/s12663-024-02122-7. Epub 2024 Feb 23.
Dexmedetomidine is a relatively new, potent, and highly selective α2-adrenergic receptor agonist used for perioperative sympatholytic, analgesia, and sedation. We conducted this study to evaluate the effects of dexmedetomidine as an adjunct to local anaesthesia for maxillofacial soft tissue injuries as day care in the emergency department on patient hemodynamics and analgesic efficacy.
Eighty patients gave informed consent to participate in the study. They were divided into Groups P and D, each of which consisted of 40 participants. Patients received saline injections in Group P, and Group D received dexmedetomidine (DEX) with local anaesthesia infiltration to both groups. Hemodynamic parameters, duration of surgery, pain of first rescue analgesia, Pain score, patient satisfaction, and surgeons satisfaction were recorded and quantified using unpaired t tests or Mann-Whitney and ANOVA tests. Data and qualitative data parameters were compared using Chi-square test. A value < 0.05 was considered significant.
Our study showed statistically significant reduced heart rate, systolic, and diastolic blood pressures in DEX compared to the placebo group where none had hypotension or bradycardia in clinical settings. The dexmedetomidine group had shorter operative time and decreased need for analgesia due to lower VAS scores. Patient and surgeon satisfaction were superior in the DEX group compared to the other groups.
Dexmedetomidine effectively suppresses the hemodynamic stress response during minor surgical procedures. We conclude that dexmedetomidine is an effective medication to be used in the emergency room for day-care procedures, as a potent analgesic, anxiolytic providing hemodynamically stable patients, with minimal side effects. We summarise that considering the above properties of dexmedetomidine can be incorporated into ERAS (early return after surgery) protocol, making it an optimal drug of choice as an alternative to moderate sedative drugs, in managing soft tissue injuries of maxillofacial region.
右美托咪定是一种相对较新的、强效且高度选择性的α2肾上腺素能受体激动剂，用于围手术期交感神经阻滞、镇痛和镇静。我们开展这项研究以评估右美托咪定作为局部麻醉辅助药物用于急诊科颌面软组织损伤日间手术时对患者血流动力学及镇痛效果的影响。
80例患者签署知情同意书参与本研究。他们被分为P组和D组，每组40名参与者。P组患者接受生理盐水注射，D组患者在局部麻醉浸润的同时接受右美托咪定（DEX）注射。记录血流动力学参数、手术时长、首次补救镇痛的疼痛情况、疼痛评分、患者满意度及外科医生满意度，并使用非配对t检验、Mann-Whitney检验和方差分析进行量化。数据和定性数据参数使用卡方检验进行比较。P值<0.05被认为具有统计学意义。
我们的研究表明，与安慰剂组相比，DEX组的心率、收缩压和舒张压在统计学上显著降低，临床中均未出现低血压或心动过缓情况。右美托咪定组的手术时间更短，由于视觉模拟评分（VAS）得分较低，镇痛需求减少。与其他组相比，DEX组的患者和外科医生满意度更高。
右美托咪定可有效抑制小型手术过程中的血流动力学应激反应。我们得出结论，右美托咪定是急诊科日间手术中一种有效的药物，作为一种强效镇痛药、抗焦虑药，可使患者血流动力学稳定，副作用最小。我们总结认为，考虑到右美托咪定的上述特性，可将其纳入加速康复外科（ERAS，术后早期恢复）方案，使其成为管理颌面区域软组织损伤时替代中度镇静药物的最佳选择药物。
