Using a Dexmedetomidine as an Opiates Reducing Agent in Laparoscopic Abdominal Surgeries

Abstract

Abstract Background The analgesic, sympatholytic, and respiratory-sparing effects of α2-agonists present a tempting option in laparoscopic abdominal surgeries. In this trial, the benefit of perioperative administration of dexmedetomidine in laparoscopic abdominal surgeries has been studied. Objective To evaluate the efficacy of dexmedetomidine infusion in patients undergoing laparoscopic abdominal surgeries as an opiates reducing agent according to the intraoperative hemodynamics and postoperative opioid analgesic rescue. Patients and Methods We conducted a double blinded 2-arms parallel controlled trial in Ain Shams University Hospitals. Sixty patients were randomly divided into two groups (30 patients in each group). Patients of group (A) received dexmedetomidine infusion 0.7 mcg/kg as a loading dose, followed by 0.2 mcg/kg/h as a maintenance intraoperative dose. Postoperative dose was 0.1 mcg/kg/h for 24 hours. Patients of group (B) received an infusion of saline without dexmedetomidine, using similar infusion sets, similar rate intraoperatively and postoperatively. Results Mean intraoperative SBP, DBP, and heart rate were all significantly lower in the dexmedetomidine group (P < 0.001). Significantly fewer patients in the dexmedetomidine group needed nitroglycerin to treat surges in SBP exceeding 20% of baseline level (P < 0.05), while more patients in this group required ephedrine to treat drops of SBP that exceeded 20% of baseline level (P > 0.05). Patients in the dexmedetomidine group consumed significantly less pethidine postoperatively (P < 0.001). Likewise, postoperative pain scores were significantly less in the dexmedetomidine group at recovery (P < 0.001), 2 h (P < 0.001), 4 h (P < 0.001), 8 h (P < 0.001), 12 h (P < 0.001), and 24 h (P < 0.001). On the other hand, patients in the dexmedetomidine group had significantly higher postoperative sedation scores at 4 h (P < 0.001), 8 h (P < 0.001), 12 h (P < 0.001), and 16 h (P < 0.001). Mean postoperative SBP, DBP, and heart rate were significantly less in the dexmedetomidine group (P < 0.001, P < 0.01, and P < 0.001, respectively). Surgeon satisfaction score was significantly higher in the dexmedetomidine group (P < 0.001). Postoperatively, there were no statistically significant differences between the two groups as regards arterial blood gases and bowel recovery (P > 0.05). Conclusion In patients undergoing laparoscopic abdominal surgeries, dexmedetomidine infusion was associated with significantly less intraoperative and postoperative SBP, DBP, MAP, heart rate, pain scores, and pethidine consumption. However, dexmedetomidine was associated with significantly higher postoperative sedation scores, with no ill-effect on ventilation. Further studies are recommended to validate the role of perioperative dexmedetomidine in laparoscopic abdominal surgeries.