This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo
Clinical Summary

Intra-operative analgesia: dexmedetomidine vs remifentanil

Takeaway

  • Moderate quality evidence suggests that intraoperative dexmedetomidine during general anaesthesia improves pain outcomes during the first 24 postoperative hours compared with remifentanil with fewer side effects.

Why this matters

  • Previous studies have investigated whether dexmedetomidine could be substituted for the intra-operative remifentanil during general anaesthesia, but these studies have reported conflicting results.

Study design

  • 21 randomised controlled trials involving 1309 patients met eligibility criteria after a search across electronic databases.
  • Primary outcome: Rest pain score at two postoperative hours.
  • Secondary outcomes: Rest pain score at 12 and 24 postoperative hours, intravenous (IV) morphine consumption at 2, 12 and 24 postoperative hours, and rates of hypotension, bradycardia, shivering and postoperative nausea and vomiting.
  • Funding: Department of Anaesthesia, Lausanne University Hospital, Lausanne, Switzerland.

Key results

  • Dexmedetomidine group had lower rest pain scores at two postoperative hours vs remifentanil group (mean difference [MD], −0.7; P=.004).
  • Rest pain score at 24 postoperative hours (P=.01) was reduced in the dexmedetomidine group vs remifentanil group, except pain score at 12 hours, which were equivalent in both groups.
  • Dexmedetomidine vs remifentanil group showed reduction in IV morphine consumption at 2 (P=.04), 12 (P<.0001) and 24 (P=.004) postoperative hours, longer time to analgesia request (P<.0001), and less need for rescue analgesics (P<.001).
  • Rates of hypotension (P=.002), shivering (P=.01) and postoperative nausea and vomiting (P<.0001) were at least twice as frequent in remifentanil compared with dexmedetomidine group, but no difference was seen in episodes of bradycardia (P=.92) between 2 groups.  

Limitations

  • Heterogeneity among studies.

References


YOU MAY ALSO LIKE