Dexmedetomidine versus fentanyl on stress response and pain control in adult patients undergoing laparoscopic surgery

Laparoscopic procedures are widely indicated; however, the ideal approach for pain control remains debatable. This trial compared between the effects of dexmedetomidine and fentanyl infusion on stress response and pain control in patients undergoing elective laparoscopic surgeries. A prospective randomized double-blinded comparative study included 82 adult participants randomly allocated into two equal-sized groups. Group D received 1 µg/kg of intravenous (IV) dexmedetomidine over 10 min as a loading dose just before induction of anesthesia, then 0.2–0.7 µg/kg/h till 10 min before the surgery ends. Group F received 1 µg/kg of IV fentanyl as a loading dose, then 0.2–0.7 µg/kg/h. Primary objective was postoperative analgesic consumption in 24 h. Collected data were heart rate (HR), mean arterial blood pressure (MAP), blood glucose and serum cortisol levels, visual analogue score (VAS), and the perioperative analgesic consumption. Group D consumed significantly less postoperative morphine doses in 24 h (p = 0.003), and 41.5% of Group D patients did not need any postoperative morphine. Group D had better-controlled hemodynamic changes 5 min post-extubation (HR and MAP p = 0.021 and p = 0.022 respectively), showed significantly less postoperative stress response as manifested in the blood glucose and serum cortisol levels 4 h postoperatively (p = 0.006 and p = 0.001 respectively), and less VAS pain scores at early and late postoperative periods. Intraoperative IV dexmedetomidine administration as a sole analgesic agent for patients undergoing elective laparoscopic surgeries serves as a convenient anesthetic approach, since it provided a good postoperative pain control, and reduced the surgical stress response and the perioperative analgesic consumption.

Dexmedetomidine; Laparoscopic surgery; Postoperative pain; Stress response; VAS score; Opioid-free anesthesia

[1] Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. British Journal of Anaesthesia. 2016; 117: 783–791.

[2] Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World Journal of Methodology. 2015; 5: 238–254.

[3] Prior SL, Barry JD, Caplin S, Min T, Grant DA, Stephens JW. Temporal changes in plasma markers of oxidative stress following laparoscopic sleeve gastrectomy in subjects with impaired glucose regulation. Surgery for Obesity and Related Diseases. 2017; 13: 162–168.

[4] Kundu S, Weiss C, Hertel H, Hillemanns P, Klapdor R, Soergel P. Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain. Archives of Gynecology and Obstetrics. 2017; 295: 1191–1199.

[5] Li Z, Xu L, Zheng J, Wang Q. Comparison of intravenous dexmedetomi-dine versus esmolol for attenuation of hemodynamic response to tracheal intubation after rapid sequence induction: a systematic review and meta-analysis. BioMed Research International. 2019; 2019: 6791971.

[6] Atkinson TM, Giraud GD, Togioka BM, Jones DB, Cigarroa JE. Cardiovascular and ventilatory consequences of laparoscopic surgery. Circulation. 2017; 135: 700–710.

[7] Marana E, Colicci S, Meo F, Marana R, Proietti R. Neuroendocrine stress response in gynecological laparoscopy: TIVA with propofol versus sevoflurane anesthesia. Journal of Clinical Anesthesia. 2010; 22: 250–255.

[8] Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. Journal of Parenteral and Enteral Nutrition. 2013; 37: 21S–29S.

[9] Shamim R, Srivastava S, Rastogi A, Kishore K, Srivastava A. Effect of two different doses of dexmedetomidine on stress response in laparoscopic pyeloplasty: a randomized prospective controlled study. Anesthesia, Essays and Researches. 2017; 11: 1030–1034.

[10] Rawal N. Current issues in postoperative pain management. European Journal of Anaesthesiology. 2016; 33: 160–171.

[11] Beleña JM, Núñez M, Vidal A, Anta D. Randomized double-blind comparison of remifentanil and alfentanil in patients undergoing laparo-scopic cholecystectomy using total intravenous anesthesia. Journal of Anaesthesiology Clinical Pharmacology. 2016; 32: 487–491.

[12] Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in Enhanced Recovery after Surgery (ERAS) protocols for postoperative pain. Current Pain and Headache Reports. 2020; 24: 21.

[13] Zhao Y, He J, Yu N, Jia C, Wang S. Mechanisms of dexmedetomidine in neuropathic pain. Frontiers in Neuroscience. 2020; 14: 330.

[14] Talke P, Anderson BJ. Pharmacokinetics and pharmacodynamics of dexmedetomidine-induced vasoconstriction in healthy volunteers. British Journal of Clinical Pharmacology. 2018; 84: 1364–1372.

[15] Geng ZY, Liu YF, Wang SS, Wang DX. Intra-operative dexmedetomidine reduces early postoperative nausea but not vomiting in adult patients after gynaecological laparoscopic surgery: a randomised controlled trial. European Journal of Anaesthesiology. 2016; 33: 761–766.

[16] Rekatsina M, Theodosopoulou P, Staikou C. Effects of intravenous dexmedetomidine versus lidocaine on postoperative pain, analgesic consumption and functional recovery after abdominal gynecological surgery: A randomized placebo-controlled double blinded study. Pain Physician. 2021;24: E997–E1006.

[17] Chilkoti GT, Karthik G, Rautela R. Evaluation of postoperative analgesic efficacy and perioperative hemodynamic changes with low dose intravenous dexmedetomidine infusion in patients undergoing laparoscopic cholecystectomy—a randomised, double-blinded, placebo-controlled trial. Journal of Anaesthesiology Clinical Pharmacology. 2020; 36: 72–77.

[18] Bielka K, Kuchyn I, Babych V, Martycshenko K, Inozemtsev O. Dexmedetomidine infusion as an analgesic adjuvant during laparoscopic сholecystectomy: a randomized controlled study. BMC Anesthesiology. 2018; 18: 44.

[19] Zhang YS, Jin LJ, Zhou X, Liu Y, Li Y, Wen LY. Effect of dexmedetomidine on stress reactions and cellular immune function of patients in perioperative period following radial resection for rectal carcinoma. Journal of Biological Regulators and Homeostatic Agents. 2018; 32: 139–145.

[20] Sharma R, Gupta R, Choudhary R, Singh Bajwa SJ. Postoperative analge-sia with intravenous paracetamol and dexmedetomidine in laparoscopic cholecystectomy surgeries: a prospective randomized comparative study. International Journal of Applied and Basic Medical Research. 2017; 7: 218–222.

[21] Ter Bruggen FFJA, Eralp I, Jansen CK, Stronks DL, Huygen FJPM. Efficacy of dexmedetomidine as a sole sedative agent in small diagnostic and therapeutic procedures: a systematic review. Pain Practice. 2017; 17: 829–840.

[22] Mishra LS, Singh V, Raw BK, Kumar S. A randomised control study of dexmedetomidine versus fentanyl as an anaesthetic adjuvant to general anaesthesia in laparoscopic surgeries. International Journal of Scientific Research. 2020; 9: 77–79.

[23] Vaswani JP, Debata D, Vyas V, Pattil S. Comparative study of the effect of dexmedetomidine vs. fentanyl on haemodynamic response in patients undergoing elective laparoscopic surgery. Journal of Clinical and Diagnostic Research. 2017; 11: UC04–UC08.

[24] Choi JW, Joo JD, Kim DW, In JH, Kwon SY, Seo K, et al. Comparison of an intraoperative infusion of dexmedetomidine, fentanyl, and remifentanil on perioperative hemodynamics, sedation quality, and postoperative pain control. Journal of Korean Medical Science. 2016; 31: 1485–1490.

[25] Khare A, Sharma SP, Deganwa ML, Sharma M, Gill N. Effects of dexmedetomidine on intraoperative hemodynamics and propofol require-ment in patients undergoing laparoscopic cholecystectomy. Anesthesia Essays and Researches. 2017; 11: 1040–1045.

[26] Wu H, Tang J, Pan J, Han M, Cai H, Zhang H. Effects of dexmedetomidine on stress hormones in patients undergoing cardiac valve replacement: a randomized controlled trial. BMC Anesthesiology. 2020; 20: 142.

[27] Kim MH, Lee KY, Bae SJ, Jo M, Cho JS. Intraoperative dexmedetomidine attenuates stress responses in patients undergoing major spine surgery. Minerva Anestesiologica. 2019; 85: 468–477.

[28] Li CJ, Wang BJ, Mu DL, Wang DX. The effect of dexmedetomidine on intraoperative blood glucose homeostasis: secondary analysis of a randomized controlled trial. BMC Anesthesiology. 2021; 21: 139.