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