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The influence of intraoperative sedative on acute postoperative pain in total knee arthroplasty under spinal anaesthesia: comparison between dexmedetomidine and propofol
Thurs, April 6, 8:15-9:45 am
Salon 5

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The influence of intraoperative sedative on acute postoperative pain in total knee arthroplasty under spinal anesthesia: comparison between dexmedetomidine and propofol

Jin-Woo Park, Hoyoung Gil, Hyun-Jung Shin, Sang-Hwan Do, Tae Kyun Kim, Hyo-Seok Na

Seoul National University Bundang Hospital

 

Introduction

Chronic post- total knee arthroplasty (TKA) pain, the prevalence of which is reported up to 47%, is associated with inadequate acute postoperative pain management.

Dexmedetomidine is a sedative-analgesic agent acting as an α2-adrenergic receptor agonist, and its analgesic effect has been shown in various procedures or surgeries.

In the present study, We compared the adjuvant analgesic role of propofol and dexmedetomidine when they were used for intraoperative sedation during TKA under spinal anesthesia.


Materials & Methods

Ethical approval was provided by the Institutional Review Board of Seoul National University Bundang Hospital (reference number: B-1603/339-005).

The dexmedetomidine group (n = 24) received 1 μg kg-1 dexmedetomidine for 10 min followed by a continuous infusion at 0.1–0.5 μg kg-1 h-1.

Propofol was infused to the propofol group (n = 24) continuously via a target-controlled infusion device, and the effect-site concentration was maintained with a range of 0.5–2.0 μg ml-1.

Numerical rating scale (NRS) for pain at rest, the cumulative amounts of fentanyl administered via intravenous patient-controlled analgesia (IV PCA), rescue analgesics, and antiemetics were compared between the two groups during the postoperative 24 h and 48 h. 

Systolic blood pressure and heart rate (HR) were recorded from the initiation of sedation until PACU discharge.


Results

Dexmedetomidine significantly reduced the consumption of fentanyl during the postoperative 24 h and 48 h (Table 1).

NRS was lower at postoperative 24 h [1.48 (0.9) vs. 2.9 (1.6), P < 0.001] and 48 h [2.3 (0.9) vs. 3.5 (1.4), P = 0.001] in the dexmedetomidine group than in the propofol group (Figure 1).

There were no significant differences in the amount of antiemetics and rescue analgesics between the two groups (Table 1).

On average, HR was 4 beats/min faster in the propofol group than in the dexmedetomidine group (P < 0.001) and significantly lower during initial 60 min of sedation period in each group (P < 0.001) (Figure 2).

 

Conclusions

Intraoperativedexmedetomidine sedation was more efficacious to relieve acute postoperative pain after TKA with less use of opioid compared to the propofol sedation. 

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