Postoperative pain control after the use of dexmedetomidine and propofol to sedate patients undergoing ankle surgery under spinal anesthesia: a randomized controlled trial

Abstract

Doyeon Kim,1,* Ji Seon Jeong,1* Huigyeong Park,1 Ki-Sun Sung,2 Soo Joo Choi,1 Mi Sook Gwak,1 Gaab Soo Kim,1 Tae Soo Hahm,1 Justin Sangwook Ko11Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Department of Orthopedics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea*These authors contributed equally to this workBackground: Dexmedetomidine is widely used for conscious sedation in patients undergoing lower-extremity surgery under regional anesthesia. We evaluated the postoperative analgesic effects of intravenous dexmedetomidine given during ankle surgery under spinal anesthesia.Methods: Forty-three participants underwent repair of lateral angle ligaments under spinal anesthesia. For sedation during surgery, participants were allocated to a dexmedetomidine group (n=22) that received a loading dose of 1 mcg.kg−1, over 10 min, followed by a maintenance dose of 0.2–0.7 μg.kg−1,.h−1,; and a propofol group (n=21) that received an effective site concentration of 0.5–2.0 μg.mL−1, via target-controlled infusion. The primary outcome was the postoperative, cumulative, intravenous (IV) morphine equivalent dose delivered via IV patient-controlled anesthesia (PCA) and rescue analgesic consumption in the first 24 h after surgery. We recorded sensory and motor block durations.Results: The postoperative IV morphine equivalent dose was 14.5 mg (0.75–31.75 mg) in the dexmedetomidine group compared to 48.0 mg (31.5–92.5 mg) in the propofol group (median difference, 33.2 mg; 95% confidence interval, 21.0–54.8 mg; P<0.001). The time to the first complaint of surgical site pain was significantly prolonged in the dexmedetomidine group (P<0.001), but the duration of motor block was comparable between the two groups (P=0.55).Conclusion: IV dexmedetomidine given as a sedative during ankle surgery under spinal anesthesia reduced postoperative opioid consumption in the first 24 h. Thus, intraoperative dexmedetomidine is a versatile sedative adjunct.Level of evidence: Level I, prospective randomized trial.Keywords: ankle surgery, dexmedetomidine, postoperative analgesia, spinal anesthesia

Keywords

• ankle surgery
• dexmedetomidine
• postoperative analgesia
• spinal anesthesia