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Dexmedetomidine added to an opioid-based analgesic regimen for the prevention of postoperative nausea and vomiting in highly susceptible patients: A randomised controlled trial

Authors
 Young Song  ;  Jae-Kwang Shim  ;  Jong-Wook Song  ;  Eui-Kyung Kim  ;  Young-Lan Kwak 
Citation
 European Journal of Anaesthesiology, Vol.33(2) : 75-83, 2016 
Journal Title
 European Journal of Anaesthesiology 
ISSN
 0265-0215 
Issue Date
2016
MeSH
Administration, Intravenous ; Adult ; Aged ; Analgesia, Patient-Controlled/adverse effects ; Analgesia, Patient-Controlled/methods* ; Analgesics, Non-Narcotic/administration & dosage* ; Analgesics, Non-Narcotic/adverse effects ; Analgesics, Opioid/administration & dosage* ; Analgesics, Opioid/adverse effects ; Chi-Square Distribution ; Dexmedetomidine/administration & dosage* ; Dexmedetomidine/adverse effects ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Fentanyl/administration & dosage* ; Fentanyl/adverse effects ; Hospitals, University ; Humans ; Linear Models ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Odds Ratio ; Orthopedic Procedures*/adverse effects ; Pain Measurement ; Pain, Postoperative/diagnosis ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control* ; Postoperative Nausea and Vomiting/chemically induced ; Postoperative Nausea and Vomiting/diagnosis ; Postoperative Nausea and Vomiting/prevention & control* ; Republic of Korea ; Risk Factors ; Tertiary Care Centers ; Time Factors ; Treatment Outcome ; Young Adult
Abstract
BACKGROUND: Dexmedetomidine, an α2 adrenergic receptor agonist, has analgesic, sedative and sympatholytic properties, with a lack of respiratory depression. It is licensed only for intensive care sedation. OBJECTIVE: The objective of this study is to investigate whether intravenous (i.v.) patient-controlled analgesia (PCA) with dexmedetomidine added to a fentanyl-based drug mixture could reduce postoperative nausea and vomiting (PONV) in highly susceptible patients undergoing lumbar spinal surgery. DESIGN: A randomised, double-blinded study. SETTING: At a tertiary university hospital between September 2012 and September 2013. PATIENTS: One hundred and eight patients undergoing level 1 or 2 posterior lumbar spinal fusion who had at least three risk factors for PONV (female, nonsmoker, use of postoperative opioids) were randomised into two groups. Three patients were excluded from analysis and 105 patients completed the study. METHODS: Patients received either dexmedetomidine 0.5 μg kg⁻¹ i.v. (dexmedetomidine group) or 0.9% normal saline (control group) 30 min before the completion of surgery followed by fentanyl 0.5 μg kg⁻¹ and 4 mg ondansetron. Postoperatively, the PCA (fentanyl 10 μg kg⁻¹ with 120 mg ketorolac, with or without dexmedetomidine 10 μg kg⁻¹ made up to a total volume of 100 ml) was programmed to deliver 1 ml bolus (lockout 15 min) with a continuous background infusion of 2 ml h⁻¹. The PCA was used for the first 48 h postoperatively. MAIN OUTCOME MEASURES: The incidence and severity of PONV, cumulative dose of PCA fentanyl consumed and pain scores were assessed for 48 h. RESULTS: The dexmedetomidine group experienced less nausea during the time interval 1 to 3 h postoperatively compared with the control group [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.13 to 0.77; P = 0.019]. The intensity of nausea between the groups during the first 48 h was comparable, but the dexmedetomidine group had a lower incidence of moderate to severe nausea (OR 0.28; 95% CI 0.12 to 0.67; P < 0.003). Pain scores were not significantly different between the groups, but patients in the dexmedetomidine group required less fentanyl and less rescue analgesia in the first 12 h. Compared with the control group, patients in the dexmedetomidine group experienced almost twice as many episodes of hypotension and bradycardia, but this failed to reach statistical significance. CONCLUSION: Adding dexmedetomidine to a fentanyl-based PCA drug mixture reduces the frequency and severity of acute postoperative nausea in highly susceptible patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01840254.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00003643-201602000-00003&LSLINK=80&D=ovft
DOI
10.1097/EJA.0000000000000327
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
곽영란(Kwak, Young Lan) ORCID logo https://orcid.org/0000-0002-2984-9927
김의경(Kim, Eui Kyung)
송영(Song, Young) ORCID logo https://orcid.org/0000-0003-4597-387X
송종욱(Song, Jong Wook) ORCID logo https://orcid.org/0000-0001-7518-2070
심재광(Shim, Jae Kwang) ORCID logo https://orcid.org/0000-0001-9093-9692
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/146249
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