Intranasal Low-Dose Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Hip Arthroplasty Under General Anesthesia

Panu Uusalo; Henrik Jätinvuori; Eliisa Löyttyniemi; Jussi Kosola; Teijo I Saari

doi:10.1016/j.arth.2018.12.036

Intranasal Low-Dose Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Hip Arthroplasty Under General Anesthesia

J Arthroplasty. 2019 Apr;34(4):686-692.e2. doi: 10.1016/j.arth.2018.12.036. Epub 2019 Jan 7.

Authors

Panu Uusalo¹, Henrik Jätinvuori², Eliisa Löyttyniemi³, Jussi Kosola⁴, Teijo I Saari¹

Affiliations

¹ Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
² Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.
³ Department of Biostatistics, University of Turku, Turku, Finland.
⁴ Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.

PMID: 30733071
DOI: 10.1016/j.arth.2018.12.036

Abstract

Background: Patients undergoing total hip arthroplasty (THA) need substantial amount of opioids for postoperative pain management, which necessitates opioid-sparing modalities. Dexmedetomidine is a novel alpha-2-adrenoceptor-activating drug for procedural sedation. In addition to its sedative effect, dexmedetomidine has analgesic and antiemetic effects. We evaluated retrospectively the effect of intraoperatively administered intranasal low-dose dexmedetomidine on postoperative opioid requirement in patients undergoing THA.

Methods: We included 120 patients with American Society of Anesthesiologists status 1-2, age between 35 and 80 years, and scheduled for unilateral primary THA under general anesthesia with total intravenous anesthesia. Half of the patients received 50 μg of intranasal dexmedetomidine after anesthesia induction, while the rest were treated conventionally. Postoperative opioid requirements were calculated as morphine equivalent doses for both groups. The impact of intranasal dexmedetomidine on postoperative hemodynamics and length of stay was evaluated.

Results: The cumulative postoperative opioid requirement was significantly reduced in the dexmedetomidine group compared with the control group (26.3 mg, 95% confidence interval 15.6-36.4, P < .001). The cumulative dose was significantly different between the groups already at 12, 24, and 36 h postoperatively (P = .01; P = .001; P < .001, respectively). Dexmedetomidine group had lower mean arterial pressure in the postanesthesia care unit compared with the control group (P = .01). There was no difference in the postanesthesia care unit stay or postoperative length of stay between the two groups (P = .47; P = .10, respectively).

Conclusion: Compared with the control group, intraoperative use of intranasal low-dose dexmedetomidine decreases opioid consumption and sympathetic response during acute postoperative period in patients undergoing THA.

Keywords: analgesia; dexmedetomidine; hip arthroplasty; intranasal; opioid crisis; pain.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Administration, Intranasal
Aged
Analgesics / therapeutic use
Analgesics, Opioid / administration & dosage*
Anesthesia, General
Arthroplasty, Replacement, Hip / adverse effects*
Dexmedetomidine / administration & dosage*
Hemodynamics
Humans
Hypnotics and Sedatives / administration & dosage*
Middle Aged
Pain, Postoperative / etiology
Pain, Postoperative / prevention & control*
Postoperative Period
Retrospective Studies

Substances

Analgesics
Analgesics, Opioid
Hypnotics and Sedatives
Dexmedetomidine