Does dexmedetomidine infusion reduce the postoperative analgesic need in lumbar disc surgery?

TL;DR

This study found that using dexmedetomidine during lumbar disc surgery did not reduce postoperative pain or opioid use.

Contribution

The study provides new evidence that dexmedetomidine infusion does not improve postoperative pain outcomes in lumbar microdiscectomy.

Findings

Dexmedetomidine infusion did not reduce postoperative pain intensity in lumbar microdiscectomy patients.

Opioid consumption was not significantly different between groups receiving or not receiving dexmedetomidine.

No significant differences in perioperative complications were observed between the groups.

Abstract

Patients experience moderate-to-severe pain, especially in the first days after lumbar disc surgery. Poorly controlled pain in the postoperative period negatively affects patient outcomes. Dexmedetomidine is a highly selective α2 adrenoceptor agonist with demonstrated analgesic efficacy. However, conflicting results have been reported in the current literature regarding the efficacy of dexmedetomidine in this surgery. In this study, we tested the hypothesis that dexmedetomidine safely improves pain scores and reduces opioid consumption in lumbar microdiscectomy.

Medical records of patients who underwent lumbar microdiscectomy with general anesthesia between January 2023 and October 2023 were retrospectively reviewed. Patients who met the inclusion criteria were divided into two groups as those who did not receive dexmedetomidine infusion (Group A) and those who received dexmedetomidine infusion (Group B). Patients in Group B received a loading dose of 1 μg/kg dexmedetomidine followed by a maintenance infusion of 0.5 μg/kg/h. The primary outcome of our study was postoperative fentanyl consumption at the 24th h. Secondary outcomes of our study included need for fentanyl in the recovery unit, postoperative pain scores at the 2nd, 6th, 12th, and 24th h and fentanyl consumption at the 2nd, 6th, and 12th h and perioperative complications.

A total of 68 patients were included in our study, 34 patients in each group. The number of patients requiring fentanyl in the recovery unit and the dose of fentanyl administered were similar in both groups (p = 0.223 and p = 0.373, respectively). There was no statistical difference in the pain scores, opioid consumption, and perioperative complications at the 2nd, 6th, 12th, and 24th h after surgery in patients receiving dexmedetomidine compared to the control group (p > 0.05).

Intraoperative dexmedetomidine infusion did not reduce postoperative pain intensity and opioid consumption in patients undergoing lumbar microdiscectomy under general anesthesia.