The influence of dexmedetomidine on opioid consumption in radical prostatectomy

Objective. Multimodal analgesia and anal-gesics with different modes of action can reduce perioperative opioid demand and their undesirable side effects. 

In our study we presumed that patients anesthetised with additional perioperative dexmedetomidine infusion, during radi-cal prostatectomy, would need less opioids during and after surgery compared to the control group.

Materials and methods. 40 patients, 18-80 years of age, ASA class 1-3 (American So-ciety of Anesthesiologists), scheduled for radical prostatectomy, were included in the study. Patients were randomly divided into two groups (20 pts in each group). In both groups, fentanyl in repeated boluses was used as an analgesic; in the studied group, an additional infusion of dexme-detomidine (0.3 µg/kg/h) was started with intravenous line insertion and continued until the beginning of wound closure. An-algesic consumption during the operation, in the post-anaesthesia care unit, in the In-tensive Care Unit on the day of the opera-tion and on the first postoperative day was recorded.

Results. The patients with perioperative dexmedetomidine infusion were slightly younger (p=0.007), also the duration of their surgery was shorter (p =0.05). Differ-ences in opioid consumption between the groups were not found. Also, pain assess-ment, by visual analogue scale (VAS) after 12, 18, 24, 30, 36 and 42 hours, was not sta-tistically different between groups. Conclusion. In our study, perioperative dexmadetomidine did not reduce peri- and postoperative opioid consumption. Also, undesirable dexmedetomidine side effects, such as bradycardia and hypoten-sion, were not observed.

dexmedetomidine, radical pros-tatectomy 

1. Frank E, Sood OP, Torjman M. Postoperative epidural analgesia following radical retropubic prostatectomy. J Surg Oncol 1998;67:117-20.

2. Ben-David B, Swanson J, Nelson JB, Chelly JE. Multimodal analgesia for radical prostatectomy provides better analgesia and shortens hospital stay. J Clin Anesth 2007;19:264-8.

3. Liu S, Carpenter RL, Neal JM. Epidural anaesthesia and analgesia. Their role in postoperative outcome. Anaesthesiology 1995;82:1474-506.

4. Kietzmann D, Bouillon T, Hamm C, Schwabe K, Schenk H, Gundert-Remy U, Kettler D. Pharmacodynamic modelling of the anal-gesic effects of piritramide in postoperative patients. Acta Anaesthiol Scand 1997;41:888-94.

5. Stenseth R, Bjella L, Berg EM, Christensen O, Levang OW, Gisvold SE. Thoracic epidural analgesia in aortocoronary bypass surgery II: effects on the endocrine metabolic response. Acta Anaesthesiol Scand 1994;38:384-9.

6. Stevens R, Mikat-Stevens M. Does the anaesthetic technique affect recovery of bowel function after radical prostatectomy? Br J Anaesth 1998;80:551-2.

7. Gruber EM, Tschernko EM, Kritzinger M, Deviatko E, Wisser W, Zurakowski D, Haider W. The effect of thoracic epidural analgesia with bupivacaine 0,25% on ventilatory mechanics in patient with severe chronic obstructive pulmonary disease. Anaesth Analg 2001;92:1015-9.

8. Jayr C, Thomas H, Rey A, Farhat F, Lasser P, Bourgain JL. Postoperative pulmonary complications: epidural analgesia using bupiv-acaine and opioids versus parenteral opiods. Anesthesiology 1993;78:666-76.

9. Clark F, Gilbert HC. Regional analgesia in the intensive care unit. Principles and prctice. Crit Care Clin 2001;17:943-66.

10. Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 2011;107:859-68.

11. Brook P, Connel J,Pickering T. Basics principles of acute pain. In: Brook P, Connel J, Pickering T, editors. Oxford handbook of pain management, Oxford: Oxford University Press; 2011. p. 3-32.

12. Mastronardi P, Cafiero T. Rational use of opioids. Minerva Anestesiol 2001;67:332-7.

13. Guingnard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P, Fletcher D, Chauvin M. Acute opiod tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000;93:407-17.

14. Brodner G, Van Aken H, Hertle L, Fobker M, Von Eckardstein A, Goeters C, et al. Multimodal perioperative management-combinig thoracic epidural analgesia forced mobilization and oral nutrition reduces hormonal and metabolic stress and improves convales-cence after major urologic surgery. Anesth Analg 2001;92:1594-600.

15. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999;54:1136-42.

16. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative analgesic agent. BUMC Proceedings 2001;14:13-21.

17. Arcangeli A, Alo C, Gaspari R. Dexmedetomidine use in general anaesthesia. Current Drug Targets 2009;10:687-95.

18. Gurbert A, Mogol EB, Turker G et al. Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. An J Anaesth 2006;53:646-52.

19. Ramsay MA, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology 2004;101:787-90.

20. Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bari-atric surgery. J Clin Anesth 2006;18:24-8.

21. Bakhames HS, El-Halafawy YM, El-Kerdawy HM, Gouda NM, Altemyatt S. Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass. Middle East J Anesthesiol 2007;19:537-51.

22. Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J, et al. Dexmedetomidine infusion during laparoscopic bari-artric surgery: the effect on recovery outcome variables. Anesth Analg 2008;106:1741-8.

23. Kamibayashi T, Maze M. Clinical uses of alpha 2-adrenergic agonists.Anesthesiology 2000;93:1345-9.

24. Kawasaki T, Kawasaki C, Ueki M, Hamada K, Habe K, Sata T. Dexmedetomidine suppreses proinflammatory mediator production in human whole blood in vitro. J Trauma Acute Care Surg 2013;74:1370-5.

25. Ahlin Č, Stupica D, Strle F, Lusa L (2015) medplot: A Web Application for Dynamic Summary and Analysis of Longitudinal Medical Data Based on R. PLoS ONE 10(4): e0121760

26. Taniguchi T, Kidani Y, Kanakura H, Takemoto Y, Yammamoto K. Effects of dexmedetomidine on mortality rate and inflammatory responses to endotoxin induced shock in rats. Crit Care Med 2004;32:1322-6.

27. Morgan LG, Ngai L, Tounou F, Auge M, Tuil O, Chazot T, et al. Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anaesthesia. A double-blind, placebo-controlled trial. Anesth Analg 2014;110:1-18.

28. Dong JG, Qi B, Tang G, Li JY. Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after histerectomy: a double- blind, randomized clinical trial. Sci Rep 2016;6:21514.

29. McQueen-Shadfar L, Megalla SA, White WD, Olufolabi AJ, Jones CA, Habib AS. Impact of intraoperative dexmedetomidine on postoperative analgesia following gynecologic surgery. Curr Med Research Op 2011;27:2091–7.

30. Courtney RJ. Perioperative uses of dexmedetomidine. Anaesthesiaclinics 2016;51:81-96.

31. Ramsay MA. Bariartric surgery: the role of dexmedetomidine. Seminars in Anesthesia, Perioperative Medicine and Pain 2006;25:51-6.

32. Hall JE, Ulrich DT, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic and analgesic properties of small-dose dexmedetomidine infu-sions. Anaesth Analg 2000;90:699-705.

33. Hofer RE, Sprung J, Sarr MG, Wedel DJ. Anaesthesia for a patient with morbid obesity dexmedetomidine without narcotics. Canad J Anesth 2005;52:176-80.

34. Jaakola ML, Salonen M, Lehtinen R, Scheinin H. The analgesic action of dexmedetomidine – a novel 2 – adrenoreceptor agonist – in healthy volunteers. Pain 1991;46:281-5.

35. Jung KP, Soon HC, Kun ML, Se HL, Jeong HL, Kwangrae C, et al. Does dexmedetomidine reduce postoperative pain after laparo-scopic cholecystectomy with multimodal analgesia? Korean J Anesthesiol 2012;63:436-40.

36. Dong JG, Qi B, Tang G, Li JY. Intraoperative dexmedetomidine promotes postoperative analgesia in patients after abdominal colec-tomy. Medicine 2015;94:1-5.

37. Jie S, Quing J, Quing S, Tao G, Kui L, Li L. The opiod-sparing effect of intraoperative dexmedetomidin infusion after craniotomy. J Neurosurg Anesthesiol 2015;00:1-7.

38. Yacout AG, Osman HA, Mamdouh HAD, Saleh AH, Mohamed ME. Effect of intravenous dexmedetomidine on some proinflamma-tory cytokines, stress hormones and recovery profile in major abdominal surgery. Alexandria J Med 2012;48:3-8.

39. Arain SR, Ruchlow RM, Ulrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004;98:153-8.

40. Nguyen NT, Lee SL, Goldman C, Fleming N, Arango A, Mc Fall R. Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass a randomized trial. J Am Coll Surg 2001;192:469-76.

41. Jeongmin K, Won OK, Hye BK, Hae KK. Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia: a dose- response study by age group. BMC Anasthesiology 2015;15:17-23.