Comparison of the perfusion index as an index of noxious stimulation in monitored anesthesia care of propofol/remifentanil and propofol/dexmedetomidine: a prospective, randomized, case-control, observational study

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Abstract

Background

Dexmedetomidine, one of the sedatives, has an analgesic effect. We aimed to investigate postoperative analgesia with dexmedetomidine as adjuvants for procedural sedation using perfusion index (PI).

Methods

In this prospective, randomized, case-control, observational study, 72 adult patients, 19–70 years, who were scheduled for chemoport insertion under monitored anesthesia care were performed. According to the group assignment, remifentanil or dexmedetomidine was simultaneously infused with propofol. The primary outcome was PI 30 min after admission to the post anesthesia care unit (PACU). And, pain severity using numerical rating scale (NRS) score and the relationship between NRS score and PI were investigated.

Results

During PACU staying, PI values were significantly different between the two groups PI values at 30 min after admission to the PACU were 1.3 (0.9–2.0) in the remifentanil group and 4.5 (2.9–6.8) in the dexmedetomidine group (median difference, 3; 95% CI, 2.1 to 4.2; P < 0.001). The NRS scores at 30 min after admission to the PACU were significantly lower in the dexmedetomidine group ( P = 0.002). However, there was a weak positive correlation between NRS score and PI in the PACU (correlation coefficient, 0.188; P = 0.01).

Conclusion

We could not find a significant correlation between PI and NRS score for postoperative pain control. Using PI as a single indicator of pain is insufficient.

Trial registration

Clinical Trial Registry of Korea, https://cris.nih.go.kr: KCT0003501, the date of registration: 13/02/2019.

Related collections

Most cited references 21

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Clonidine has proved to be a clinically useful adjunct in clinical anaesthetic practice as well as in chronic pain therapy because it has both anaesthetic and analgesic-sparing activity. The more selective alpha-2 adrenoceptor agonists, dexmedetomidine and mivazerol, may also have a role in providing haemodynamic stability in patients who are at risk of peri-operative ischaemia. The side-effects of hypotension and bradycardia have limited the routine use of alpha-2 adrenoceptor agonists. Investigations into the molecular pharmacology of alpha-2 adrenoceptors have elucidated their role in the control of wakefulness, blood pressure and antinociception. We discuss the pharmacology of alpha-2 adrenoceptors and their therapeutic role in this review. The alpha-2 adrenoceptor agonists are agonists at imidazoline receptors which are involved in central blood pressure control. Selective imidazoline agonists are now available for clinical use as antihypertensive agents and their pharmacology is discussed.

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This prospective, randomized, double-blind study was designed to assess whether intraoperative infusion of dexmedetomidine provides effective postoperative analgesia. Postoperative pain scores and morphine consumption were compared in a treated group and a placebo group, both of which received patient-controlled morphine after total abdominal hysterectomy. Fifty women were randomly assigned to two groups. Group D (n = 25) received a loading dose of dexmedetomidine 1 mug.kg(-1) iv during induction of anesthesia, followed by a continuous infusion at a rate of 0.5 mug.kg(-1).hr(-1) throughout the operation. Group P (n = 25) received a volume-matched bolus and infusion of placebo (0.9% saline). For each case, heart rate, peripheral oxygen saturation, and systolic and diastolic blood pressure were recorded intraoperatively and for 48 hr postoperatively. Patients used a patient-controlled analgesia device to receive bolus doses of morphine after surgery. Total morphine consumption, pain scores, and sedation scores were recorded for the first 48 hr (two hours in the postanesthesia care unit and 46 hr on the ward). The groups were similar with respect to mean times to extubation of the trachea. Pain and sedation scores were also similar between groups at all corresponding times throughout the 48-hr period of observation. Group D patients consumed significantly less morphine in the postanesthesia care unit and on the ward (P < 0.05 and P < 0.01, respectively). Fewer patients in Group D experienced itching or nausea/vomiting (P < 0.05). Continuous iv dexmedetomidine during abdominal surgery provides effective postoperative analgesia, and reduces postoperative morphine requirements without increasing the incidence of side effects.

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Author and article information

Contributors

Ji Seon Jeong: jiseon78.jeong@samsung.com

Journal

Journal ID (nlm-ta): BMC Anesthesiol

Journal ID (iso-abbrev): BMC Anesthesiol

Title: BMC Anesthesiology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2253

Publication date (Electronic): 26 May 2023

Publication date PMC-release: 26 May 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 183

Affiliations

[1 ]GRID grid.452398.1, ISNI 0000 0004 0570 1076, Department of Anesthesiology and Pain Medicine, , CHA Bundang Medical Center, CHA University School of Medicine, ; Seongnam, Korea

[2 ]GRID grid.264381.a, ISNI 0000 0001 2181 989X, Department of Anesthesiology and Pain Medicine, , Samsung Medical Center, Sungkyunkwan University School of Medicine, ; Seoul, Korea

[3 ]GRID grid.254224.7, ISNI 0000 0001 0789 9563, Department of Anesthesiology and Pain Medicine, , Chung-Ang University Gwangmyeong Hospital, Chung-Ang University Scholl of Medicine, ; Gwangmyeong, Korea

[4 ]GRID grid.264381.a, ISNI 0000 0001 2181 989X, Department of Anesthesiology and Pain Medicine, , Samsung Medical Center, Sungkyunkwan University School of Medicine, ; 81 Irwon-ro, 06351 Gangnam, Seoul, Korea

Article

Publisher ID: 2116

DOI: 10.1186/s12871-023-02116-x

PMC ID: 10214613

PubMed ID: 37237353

SO-VID: 0f391d2a-e151-4ef1-8d81-e26b5694e10b

License:

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