Table 3.
Study | Design | Fixed TRT (drug) for all groups | Postoperative pain outcome assessment and time points | Authors conclusion / DEX reported complications |
---|---|---|---|---|
Dong et al.[14], 2017 | Two parallel groups, N= 60 G1: PCIA (n=30) G2: DEX 4 mcg/kg added to PCIA (n=30) Surgery (n of CO, n of DEX): elective major open thoracotomy operations include esophageal neoplasia resection (16, 17), lobectomy (6, 7), pneumonectomy (1, 2), mediastinal mass (2, 2), and pneumothorax (5, 2) INT duration: the first 48h postop period Mean of age: G1=57.3 G2= 55.4, range=32-65 y M/F: 19/31 |
PCIA program: Drug: SUF 3.0 mcg/kg plus 8mg ondansetron Loading: 20 ml On demand: 2 ml Lock-out: 10 min Background: 4 ml |
Outcomes: SUF consumption in the 48h postop period,
the mean of pain intensity, the number of PCIA self-administer
and meperidine injection Interval: 2, 6, 12, 24, 36 and 48h postop period Scales: VAS |
The combination of DEX and SUF in PCIA reduces SUF
consumption, the pain intensity, and supplemental analgesic
requirements, while maintaining a good hemodynamic
stability. DEX reported complications: bradycardia, hypotension, over sedation |
Dutta et al.[15], 2017 | Two parallel groups, N= 30 G1: Standard drug (n=15) G2: a bolus of DEX 1 mcg/kg over 3 to 5 minutes followed by an infusion of 0.2 mcg/kg/hour added to standard drug (n=15) Surgery (n of CO, n of DEX): elective lung surgeries via anterolateral or posterolateral thoracotomy including lobectomy (2, 8), pneumonectomy (5, 5), cyst excision (5, 0), decortication (2, 2), and bullectomy (1, 0) INT duration: the first 24h postop period Mean of age: G1=34.4 G2= 42.1, range=18-70 M/F: 20/10 |
Standard drug: A bolus of 15 mL of 0.75% ROPI over 3 to 5 minutes, followed by an infusion of 0.2% ROPI at 0.1 mL/kg/h Thoracic paravertebral block by lignocaine 2% (3 mL) with adrenalin up to 72 hours after surgery |
Outcomes: Intraoperative anesthetic drug
requirement, pain scores, rescue analgesic use requirement, and
incidence of pain syndrome in 2 months Intervals:1, 2, 3, 4, 8, 12, 16, 20, and 24h postop period Scales: VAS |
Paravertebral DEX administration is associated with
lower number of rescue analgesia, morphine required, total
intraoperative fentanyl dose, propofol induction dose, and lower
postop pain in 1, 2, 4, and 8 hours. DEX fails to lower the incidence of post-thoracotomy pain syndrome. DEX reported complications: bradycardia, hypotension, over sedation |
Jabbary Moghaddam et al.[16], 2016 | Two parallel groups; N=104 G1: IV infusion of DEX 0.5 mcg/kg/h (n=50) G2: NS (n=54) Surgery (n of CO, n of DEX): elective CABG INT duration: from the initiation of anesthesia until extubation in the ICU Mean of age: G1=57.3, G2= 55.4 M/F: 71/33 |
None | Outcomes: the NRS score after surgery and the
incidence of postop pain by telephone interview Intervals: two months scale: NRS and BPI |
The incidence of postop was significantly lower in
the DEX group than that of the control group. Pre-emptive intraoperative DEX may reduce pain DEX reported complications: not reported |
Cai et al.[17], 2016 | Two parallel groups; N= 94 G1: DEX at a loading dose of 1 mcg/kg for 10 minutes, followed by continuous infusion at 0.5 mcg /kg/h (n=46) G2: NS (n=48) Surgery (n of CO, n of DEX): thoracic surgeries including thoracoscopic lobectomy (12, 10), open thoracic lobectomy (4, 6), incision of esophageal cancer (32, 30) INT duration: the first 48h postop period Mean of age: G1=54.6 G2= 55.4, range=18-65 M/F: 94/0 |
PCIA program: Drug: SUF 0.8 mg/mL Loading: 2 mL On demand: none Lock-out: 5 min Background: a 4-hour limit of 30 to 40 mL of SUF |
Outcomes: The mean of pain at rest and with
coughing and dosage of SUF during surgery Intervals: at arrival, 1, 4h, and every 4h thereafter until the 48h postop period Scales: NRS |
Intraoperative DEX can reduce the opioid
requirement and pain intensity, as well as reduce the cumulative
dosage of SUF, NRS at rest, and NRS with coughing
scores. DEX reported complications: bradycardia |
Priye et al.[18], 2015 | Two parallel groups; N= 64 G1: IV infusion of DEX 0.4 mcg/kg/h for 12h without a loading dose, (n=32) G2: NS (n=32) Surgery: elective cardiac surgery using cardiopulmonary bypass (CPB) including coronary artery bypass graft, valve surgery, and atrial septal defect closure. (Note: the number of subjects in each category was not identified by authors) INT duration: Intraoperative until the first 24h postop period Mean of age: G1=41.4 G2= 45.1, range= over 18 M/F: 33/31 |
None | Outcomes: Postop pain and total fentanyl consumption Intervals: 6, 12, 18, and 24h Scales: VAS | DEX is associated with lower pain score at 0, 6,
12, 18 and 24h postop period and fewer fentanyl consumption than
normal saline. Also, DEX could reduce the incidence of
delirium. DEX reported complications: without significant complications |
Ren et al.[19], 2015 | Three parallel groups; N= 125 G1: SUF 0.02 mcg/kg/h, (n=41) G2: SUF 0.02 mcg/kg/h plus DEX 0.02 mcg/kg/h each (n=41) G3: SUF 0.02 mcg/kg/h plus IV infusion of DEX 0.04 mcg/kg/h (n=43) Surgery (n of CO, n of DEX1, 2): thoracic surgeries including thoracotomy in esophageal (one incision) (35, 34, 36) and thoracotomy in cardiac cancer (6, 7, 7) INT duration: the first 72h postop period Mean of age: G1=59.8, G2= 59.9, G3=60.5, range=35-65 M/F: 125/0 |
PCIA program: Drug: SUF 0.8 mg/mL Loading: 2 mL On demand: none Lock-out: 5 min Background: 2 ml/h, 4h limit of 40 ml Intraoperative DEX: a small bolus of 0.5 mcg/kg then reduced to 0.5 mg/kg/h |
Outcomes: cumulative amount of self-administered
SUF and the postop pain intensity scores both at rest and with
coughing Intervals: 1, 4, 8, 16, 24, 48, and 72h Scales: NRS |
Addition of DEX 0.04 mcg/kg/h to SUF improves the
analgesic effect of SUF and is associated with greater patient
satisfaction without side effects. This combination could
decrease the total dosage of SUF during the first 72h after
surgery. DEX reported complications: without significant complications |
Ramsay et al.[20], 2014 | Two parallel groups; N= 38 G1: IV infusion of DEX 0.1 to 0.5 mcg/kg/h, (n=19) G2: NS (n=19) Surgery: major open lateral thoracotomy (Note: sub-categories of thoracotomy has not been identified by authors) INT duration: 18 to 24h postop period Up to 24h after that (42-48h postop) Mean of age: G1=61, G2= 56, range=18-85 M/F: 15/23 |
PCIA Drug: MO Protocol: not reported, but the two groups were similar in the types of PCA pumps and supplemental opioids used Intraoperative: DEX at 0.2 to 0.5 mcg/kg/h without bolus until 30 minutes prior to transfer to the telemetry unit |
Outcomes: the amount of self-administered opioid
medication and average pain scores Intervals: 24h after ICU discharge and 24 to 48h postop Scales: VAS |
In comparison with normal saline, DEX is associated
with lower morphine consumption, however, the mean pain scores
between DEX and normal saline groups were similar. DEX reported complications: hypotension, bradycardia |
Abdel-Meguid[21], 2013 | Two parallel groups; N= 30 G1: DEX at 0.5 mcg/kg/h after the induction of anesthesia, that reduced to 0.3 mcg/kg/h on admission in the ICU and continued for 12h post extubation (n=15) G2: NS (n=15) Surgery: elective coronary artery surgery using OPCAB technique INT duration: The first 12h post extubation Mean of age: G1=55, G2= 52 M/F: 23/7 |
MO for postop pain management | Outcomes: The median of postop pain and total dose
of MO Intervals: 2, 4, 6, 8, 10, 12h postop Scales: VAS |
DEX showed a better pain control, a lower
consumption of narcotics and earlier extubation time. DEX reported complications: not reported |
Elhakim et al.[22], 2010 | Two parallel groups; N= 50 G1: DEX 1 mcg/kg plus bupivacaine 0.5% via epidural catheter (n=25) G2: bupivacaine 0.5% via epidural catheter (n=25) Surgery (n of CO, n of DEX): elective open thoracotomy for lung surgery with one-lung ventilation including right lobectomy (12, 11), right pleurectomy (7, 7), and right pneumectomy (6, 7) INT duration: after induction of general anesthesia until the first 24h postop period Mean of age: G1=52, G2=50, range=43-54 M/F: 50/0 |
Drug: IV crystalloids colloids and fentanyl bolus dose were added to the epidural medication |
Outcomes: Postop pain scores, and postop analgesic
use requirement Intervals: at 6, 12, 18, and 24h after
surgery Scales: VRS |
Epidural use of DEX decreases the anesthetic
requirements and improves postoperative analgesia as well as
shorter the ICU stay DEX reported complications: without significant complications |
Ghandi et al.[23], 2005 | Two parallel groups; N=100 G1: MO 0.2 mg via PCIA at 4 ml/h (n=50) G2: DEX 0.2 mcg/kg via PCIA (n=50) Surgery: candidates for open cardiac surgery INT duration: after surgery until the first 24h postop Mean of age: G1=66.7, G2= 65.4, range=54-81 M/F: not reported |
PCIA, but the protocol not reported by authors | Outcomes: The mean of postop pain intensity and
intravenous MO consumption Intervals: 2, 4, 6, 8,10,12, 14, 16 and 18h postop Scale: VAS |
DEX is associated with lower pain score in the 2,
4, 6, 8, 10 and 12h postop periods. Male patients experienced
lower pain than female in the DEX group. DEX reduced the IV MO
consumption during ICU stay. DEX shortened the intubation
time. DEX reported complications: without significant complications |
Wahlander et al.[24], 2005 | Two parallel groups; N= 28 G1: IV loading dose of DEX 0.5 mcg/kg over 20 minutes, followed by continuous IV infusion at 0.4 mcg/kg/h, (n=14) G2: NS (n=14) Surgery: elective thoracotomy for wedge resection, lobectomy, or pneumonectomy (Note: the number of subjects in each category was not identified by authors) INT duration: the first 24h post ICU Mean of age: G1=67.7, G2= 65.7, range= over 18 M/F: 12/16 |
In the operating room, a TEC loaded using 3 mL of
1.5% lidocaine-epinephrine mixture. PCEA program: Loading: 3 mL 0.125% (3.75 mg) bupivacaine, Lock-out: 20 min Background: 4-hour limit of 30 mL 0.125% (37.5 mg) bupivacaine |
Outcomes: need for additional epidural bupivacaine
administered by PCEA and the requirement for supplemental
opioids (fentanyl) Intervals: at admission to SICU or PACU (zero time point) and then in 1, 2, 3, 4, 12, 16, and 24h postop periods Scales: VAS |
IV DEX has beneficial analgesic effects on
post-thoracotomy pain when using as an addition to a thoracic
epidural infusion of 0.125% bupivacaine. It is unable to decrease the PCEA requirement, but is able to decrease the requirement for opioids and likelihood of respiratory depression DEX reported complications: hypotension and bradycardia |
Venn et al.[25], 1999 | Two parallel groups; N= 98, cardiac
(n=81) G1: IV DEX at a loading dose of 1 mcg/kg over 10 min followed by a maintenance infusion rate of 0.2-0.7 mcg/kg/h, maximum infusion rate of 0.7 mcg/kg/h (n=39) G2: NS (n=42) Surgery: cardiac surgery using cardiopulmonary bypass (n=81) and general surgery (n=17) INT duration: within 1h of arrival on the ICU until the first 24h after that Mean of age: G1=63.3, G2= 64.2, range= over 18 M/F: 54/27 |
MID 0.01-0.2 mg/kg/h and MO | Outcomes: postoperative analgesia (MO) Intervals: hourly up to first 24h postop period Scales: VAS |
Intubated patients receiving DEX required 80% less
MID and 50% less MO DEX could reduce the requirements for rescue sedation and analgesia in postop patients for up to 24h. MO requirement was reduced by half in the DEX group. DEX reported complications: bradycardia and hypotension |
ABG=arterial blood gas; BP=blood pressure; BPI=brief pain inventory; C=control; CABG=coronary artery bypass graft; DEX=dexmedetomidine; G= group; HR=heart rate; ICU=intensive care unit; INT=Intervention; M/F=male/female number; MO=morphine; NR=not recorded; NRS=numeric rating scale; NS=normal saline; NV=nausea and vomiting; OAA=Observer's Assessment of Alertness/Sedation; OPCAB=off‑pump coronary artery bypass; PCEA=patient-controlled epidural analgesia; PCIA=patient-controlled intravenous analgesia; PNRS: pain number rating scale; Postop=postoperative; Preop=preoperative; RCT=randomized controlled trial; ROPI=ropivacaine; RSS=Ramsey sedation scale; TEC=thoracic epidural catheter; TRT=treatment; VAS=visual analogue scale; VRS=verbal rating score