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Postoperative pain status after intraoperative systemic dexmedetomidine and epidural neostigmine in patients undergoing lower abdominal surgery

Published online by Cambridge University Press:  01 November 2008

K. Kida ,
N. Ohtani ,
K. Shoji ,
Y. Yasui  and
E. Masaki
K. Kida
Affiliation:
Jikei University School of Medicine, Department of Anesthesiology, Tokyo
N. Ohtani
Affiliation:
Tohoku University Hospital, Department of Anesthesiology, Sendai, Japan
K. Shoji
Affiliation:
Jikei University School of Medicine, Department of Anesthesiology, Tokyo
Y. Yasui
Affiliation:
Jikei University School of Medicine, Department of Anesthesiology, Tokyo
E. Masaki*
Affiliation:
Tohoku University Hospital, Department of Anesthesiology, Sendai, Japan
*
Correspondence to: Eiji Masaki, Department of Anesthesiology, Tohoku University Hospital, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan. E-mail: ejmasaki@mail.tains.tohoku.ac.jp; Tel: +81 22 717 7321; Fax: +81 22 717 7325
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Summary

Background and objectives

To determine whether intraoperative systemic dexmedetomidine improves postoperative pain and interacts with epidural neostigmine to produce analgesic effects.

Methods

Sixty patients undergoing gynaecological surgery were randomly divided into four groups to receive epidural neostigmine and/or systemic dexmedetomidine: control (Group C), epidural neostigmine (Group N), systemic dexmedetomidine (Group D) and co-administered neostigmine and dexmedetomidine (Group ND). Epidural neostigmine (0.3 mg) was administered with 10 mL of 0.75% ropivacaine before the induction of general anaesthesia. Systemic dexmedetomidine (loading dose of 1 μg kg−1 over 10 min followed by 0.4 μg kg−1 h−1) was infused after the induction of general anaesthesia and continued until the end of surgery. The pain status of patients was assessed using the visual analogue scale at 2, 4, 6, 24 and 72 h postoperatively.

Results

Intraoperative systemic dexmedetomidine alone did not reduce postoperative pain scores. However, co-administered neostigmine and dexmedetomidine significantly decreased scores at 24 and 72 h (Group C: 3.0 [1.0–5.8] and 2.0 [0.3–3.0]; Group N: 1.5 [0.3–3.4] and 0 [0–1.3]; Group D: 3.5 [0–5.0] and 0 [0–1.4]; and Group ND: 0 [0–1.0]* and 0 [0–0]†; median [interquartile range] *P = 0.0031, †P = 0.0045 compared with Group C).

Conclusions

The intraoperative systemic infusion of dexmedetomidine alone at doses causing sedation does not result in postoperative analgesic effects. However, the co-administration of systemic dexmedetomidine and epidural neostigmine at higher doses may be a useful method to improve postoperative pain although side-effects have to be evaluated.

Keywords

PAIN ACUTE AND POSTOPERATIVEDEXMEDETOMIDINENEOSTIGMINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 11 , November 2008 , pp. 869 - 875
Copyright
Copyright © European Society of Anaesthesiology 2008

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