Comparison of the Effect of Dexmedetomidine and Remifentanil on Pain Control After Spinal Surgery: A Double-Blind, Randomized Clinical Trial

Background: A variety of spinal surgery procedures are performed on patients with different cardiac, vascular, and respiratory comorbidities. Postoperative pain management is a major determinant of hemodynamic and respiratory status in these patients and promotes clinical results, prevents complications, saves health services, and improves the quality of life of patients. Objectives: We compared the effects of dexmedetomidine and remifentanil on pain control after spinal surgery. Methods: Sixty patients aged 18 - 65 years undergoing spinal surgery were randomized into the two groups of dexmedetomidine and remifentanil. The dexmedetomidine group (group D, n = 30) received dexmedetomidine infusion (0.6 mcg/kg/h), and the remifentanil group (group R, n = 30) received remifentanil infusion (0.1 mcg/kg/min) from induction of anesthesia until extubation. Propofol (1.5 mg/kg) and fentanyl (2mcg/kg) were used to initiate anesthesia, and propofol (100 - 150 mcg/kg/min) was infused to maintain anesthesia. Postoperative pain, hemodynamic parameters, and recovery characteristics were evaluated after surgery. Results: The mean pain intensity in the dexmedetomidine group was significantly lower than in the remifentanil group (2.98 ± 1.29 vs. 3.80 ± 1.1; P < 0.001). Hemodynamic changes in the dexmedetomidine group (MAP: 92.60 ± 5.56, HR: 73.07 ± 7) were less, and their condition was significantly more stable than in the remifentanil group (MAP: 93.85 ± 4.78, HR: 79.15 ± 7.03; P < 0.05). The mean arterial oxygen saturation (O2 sat) in the dexmedetomidine group was significantly higher and more stable than in the remifentanil group (98.87 ± 0.51 vs. 97.92 ± 0.46; P < 0.05). The incidence of nausea and vomiting was significantly lower in the dexmedetomidine group compared to the remifentanil group (P < 0.05). The administration of analgesics in the post-anesthetic care unit (PACU) was significantly higher in the remifentanil group than the dexmedetomidine group (P = 0.016). Conclusions: Anesthetic maintenance with either dexmedetomidine or remifentanil infusion until extubation provided more smooth and hemodynamically stable conditions, without complications. However, dexmedetomidine provides better analgesia, causes a more stable hemodynamic state, and reduces postoperative nausea-vomiting, shivering, and the need for analgesics.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.0.8877 ◽

2020 ◽

pp. 1-6

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

Electroconvulsive therapy (ECT) is one of the appropriate treatments for many neuropsychiatric patients, especially those with mood disorders. Short-term complications of ECT include agitation and postictal. In this study, we compared the addition of dexmedetomidine or remifentanil to thiopental as the main anaesthetic used in ECT. In this double-blind randomised clinical trial, 90 patients with mood disorders (candidates for ECT) were divided into two groups based on their therapy: dexmedetomidine or remifentanil. In the first group (DG), patients were slowly injected intravenously with 0.5 μg/kg dexmedetomidine before induction of anesthesia. In the second group (GR), 100 μg of remifentanil was slowly injected intravenously.In addition, we collected demographic information such as respiratory rate, heart pulse rate, seizure time, mean of arterial blood pressure, recovery duration and the oxygen arterial saturation recorded after recovery. Data obtained were analysed by use of statistical software, SPSS-23. The mean age of both groups was approximately 37 years with the majority being men. There was no significant difference between the two groups in terms of age and sex, blood pressure, heart rate, duration of seizures and arterial oxygen saturation before ECT. The mean blood pressure and heart rate in the recovery group were lower in the dexmedetomidine group than in the remifentanil group and the hemodynamics in the dexmedetomidine group were more stable. The recovery time in the dexmedetomidine group was longer than that of the remifentanil group (p = 0.001). Both groups had approximately the same satisfaction and the rate of agitation after ECT was the same. Both remifentanil and dexmedetomidine as adjuvants lead to a decrease in patients' post-ECT hyperdynamic responses. In our study, we demonstrated that the effect of dexmedetomidine is greater than remifentanil. On the other hand, neither dexmedetomidine nor remifentanil had a negative effect on seizure duration, but dexmedetomidine significantly prolonged recovery time, when compared to remifentanil.

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Effect of adding dexmedetomidine or remifentanil to thiopental in patients with mood disorder candidate for electroconvulsive therapy

European Journal of Translational Myology ◽

10.4081/ejtm.2020.8877 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Faezeh Heidarbeigi ◽

Hamidreza Jamilian ◽

Anita Alaghemand ◽

Alireza Kamali

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Mood Disorders ◽

Electroconvulsive Therapy ◽

Recovery Time ◽

Arterial Oxygen ◽

Arterial Blood ◽

Significant Difference ◽

The Mean ◽

Remifentanil Group

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Acute Opioid Tolerance

Anesthesiology ◽

10.1097/00000542-200008000-00019 ◽

2000 ◽

Vol 93 (2) ◽

pp. 409-417 ◽

Cited By ~ 611

Author(s):

Bruno Guignard ◽

Anne Elisabeth Bossard ◽

Carole Coste ◽

Daniel I. Sessler ◽

Claude Lebrault ◽

...

Keyword(s):

Postoperative Pain ◽

Rapid Development ◽

Interquartile Range ◽

Morphine Consumption ◽

Opioid Tolerance ◽

Remifentanil Infusion ◽

Autonomic Responses ◽

Group Assignment ◽

Pain Scores ◽

Remifentanil Group

Background Rapid development of acute opioid tolerance is well established in animals and is more likely to occur with large doses of short-acting drugs. The authors therefore tested the hypothesis that intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain and opioid requirement. Methods Fifty adult patients undergoing major abdominal surgery were randomly assigned to two anesthetic regimens: (1) desflurane was kept constant at 0.5 minimum alveolar concentrations and a remifentanil infusion was titrated to autonomic responses (remifentanil group); or (2) remifentanil at 0.1 microg. kg-1. min-1 and desflurane titrated to autonomic responses (desflurane group). All patients were given a bolus of 0.15 mg/kg morphine 40 min before the end of surgery. Morphine was initially titrated to need by postanesthesia care nurses blinded to group assignment. Subsequently, patients-who were also blinded to group assignment-controlled their own morphine administration. Pain scores and morphine consumption were recorded for 24 postoperative h. Results The mean remifentanil infusion rate was 0.3 +/- 0.2 microg. kg-1. min-1 in the remifentanil group, which was significantly greater than in the desflurane group. Intraoperative hemodynamic responses were similar in each group. Postoperative pain scores were significantly greater in the remifentanil group. These patients required morphine significantly earlier than those in the desflurane group and needed nearly twice as much morphine in the first 24 postoperative h: 59 mg (25-75% interquartile range, 43-71) versus 32 mg (25-75% interquartile range, 19-59; P < 0.01). Conclusions Relatively large-dose intraoperative remifentanil increased postoperative pain and morphine consumption. These data suggest that remifentanil causes acute opioid tolerance and hyperalgesia.

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Perioperative Pregabalin for Postoperative Pain Control and Quality of Life After Major Spinal Surgery

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e31823a885b ◽

2012 ◽

Vol 24 (2) ◽

pp. 121-126 ◽

Cited By ~ 51

Author(s):

Lara Gianesello ◽

Vittorio Pavoni ◽

Elisabetta Barboni ◽

Ilaria Galeotti ◽

Alessandra Nella

Keyword(s):

Quality Of Life ◽

Postoperative Pain ◽

Spinal Surgery ◽

Pain Control ◽

Postoperative Pain Control

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A comparison of the effects of remifentanil infusion compared with conventional anaesthesia on postoperative pain in patients undergoing spinal surgery

http://isrctn.org/> ◽

10.1186/isrctn84240582 ◽

2012 ◽

Author(s):

P Burford

Keyword(s):

Postoperative Pain ◽

Spinal Surgery ◽

Remifentanil Infusion

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A Comparison of Three Types of Postoperative Pain Control After Posterior Lumbar Spinal Surgery

Spine ◽

10.1097/brs.0b013e318205e3d7 ◽

2011 ◽

Vol 36 (25) ◽

pp. 2224-2231 ◽

Cited By ~ 17

Author(s):

Meng-Huang Wu ◽

Chung-Hang Wong ◽

Chi-Chien Niu ◽

Tsung-Ting Tsai ◽

Lih-Huei Chen ◽

...

Keyword(s):

Postoperative Pain ◽

Spinal Surgery ◽

Pain Control ◽

Postoperative Pain Control ◽

Lumbar Spinal Surgery ◽

Lumbar Spinal

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Effect of Perioperative Lignocaine Infusion on Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy

10.53350/pjmhs211581814 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1814-1816

Author(s):

Saadia Khaleeq ◽

Kiran Riaz Khan ◽

Muhammad Azam ◽

Abaid-Ur- Rehman ◽

Muhammad Usman Jahangir ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Pain ◽

General Anesthesia ◽

Pain Score ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Control Group ◽

Lidocaine Group ◽

Arterial Blood ◽

The Mean

Background: Pain is a common complaint of patients after surgery. Different techniques or medications including local anesthetics infiltration, non-steroidal anti-inflammatory drugs or opioids have been used for postoperative analgesia. Lidocaine is an amide local anesthetic agent that works by influencing the complex phenomenon of pain. Aim: To compare the mean pain score with intraoperative lidocaine versus control in patients undergoing laparoscopic cholecystectomy under general anesthesia. Methods: 350 patients aged 20-60 years of either sex scheduled for laparoscopic cholecystectomy were included in the study. Patients with allergy to lidocaine; patients with neuromuscular disease, endocrine or metabolic disorder and pregnant patients were excluded from study. Patients were randomly divided in two groups by using lottery method after taking informed consent. On arrival to the operating room, monitor was attached to display continuous ECG, mean arterial blood pressure, and arterial oxygen saturation. Results: In lidocaine group, the mean age of patients was 39.93±11.56years. In control group, the mean age of patients was 37.93±11.83years. In lidocaine group, there were 91 (52%) males and 84 (48%) females. In control group, there were 77 (44%) males and 98 (56%) females. In lidocaine group, the mean BMI of patients was 26.66±4.81kg/m2. In control group, the mean BMI of patients was 26.77±4.76kg/m2. In lidocaine group, the mean pain score of patients was 1.00±0.84. In control group, the mean pain score of patients was 2.39±1.10. The difference was significant (p<0.05). Conclusion: Thus lidocaine is found to be more effective in reducing postoperative pain than control. Keywords: General anesthesia, laparoscopic cholecystectomy, lidocaine, postoperative pain.

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