Efficacy of dexmedetomidine-based opioid-free anesthesia on the control of surgery-induced inflammatory response and outcomes in patients undergoing open abdominal hysterectomy

Abstract

Objectives To compare the effect of opioid-based (OB-GA) versus opioid-free intraoperative analgesia during general anesthesia (OF-GA) and epidural anesthesia (EA) during open abdominal hysterectomy on pro-inflammatory cytokines’ levels estimated in blood samples obtained at end of surgery (S2) and 24-hr (S3) postoperative (PO).Patients Patients of OF-GA group received loading doses of dexmedetomidine (DEX; 0.6 µg/kg) and Lidocaine (LID; 1.5 mg/kg) and intraoperative (IO) DEX (1 µg/kg) and LID (20 mg/ ml) infusions. GA was provided as sevoflurane inhalational anesthesia and EA was provided as loading dose (15 ml) of 0.5% bupivacaine and intermittent doses if required. The study outcome is the effect of anesthetic techniques on S2 and S3-samples’ serum cytokines’ levels.Results PO serum cytokines’ levels were significantly higher than preoperative levels with significantly higher levels in S2-sample of patients OB-GA patients compared to patients of other groups. In the S3 sample, serum cytokines’ levels were decreased after OB-GA but increased after OF-GA and EA. OF-GA provided better IO hemodynamic control and PO lower cytokines’ levels, pain scores and consumption of rescue analgesia. Satisfaction scores were significantly higher by OF-GA and LA.Conclusion DEX-based OF-GA provided better IO and PO control on surgical inflammatory response with improved PO outcomes regarding analgesia and adverse effects. EA also allowed IO control on cytokines’ levels but PO rebound was detected.

Keywords

• Opioid-free
• epidural anesthesia
• general anesthesia
• hysterectomy
• inflammatory cytokines