PMID- 24692779
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20140402
LR  - 20220318
IS  - 0011-393X (Print)
IS  - 0011-393X (Linking)
VI  - 69
IP  - 1
DP  - 2008 Feb
TI  - Dexmedetomidine as an adjunct to epidural analgesia after abdominal surgery in 
      elderly intensive care patients: A prospective, double-blind, clinical trial.
PG  - 16-28
LID - 10.1016/j.curtheres.2008.02.001 [doi]
AB  - BACKGROUND: The ideal postoperative analgesia management of elderly surgical 
      patients in intensive care units (ICUs) is continually being investigated. 
      OBJECTIVE: The purpose of this study was to assess the effectiveness and 
      tolerability of IV administration of dexmedetomidine as an adjunct to a low-dose 
      epidural bupivacaine infusion for postoperative analgesia after abdominal surgery 
      in elderly patients in the ICU. METHODS: ICU patients aged >70 years undergoing 
      abdominal surgery were eligible for the study. A lumbar epidural catheter was 
      inserted at the beginning of the surgery with no medication. On arrival at the 
      ICU, the catheter was loaded with 0.25% bupivacaine 25 mg at the T8 to T10 
      sensory level, and a continuous infusion of 0.125% bupivacaine was started at 4 
      to 6 mL/h in combination with patient-controlled epidural analgesia (PCEA) of 
      fentanyl (4 mug/bolus) for pain treatment. Patients in the treatment group 
      received dexmedetomidine as an IV loading dose of 0.6 pg/kg for 30 minutes 
      followed by continuous infusion at 0.2 mug/kg . h(-1). Patients in the control 
      group were not administered dexmedetomidine. The effectiveness of the pain relief 
      was determined using a visual analog scale (VAS) (0 = no pain to 10 = worst pain 
      imaginable) at rest. VAS score, heart rate (HR), systolic blood pressure (SBP), 
      diastolic blood pressure, and arterial blood gases were monitored periodically 
      for 24 hours after surgery. If required, tenoxicam (20-mg IV bolus) was used to 
      ensure a VAS score of </=3. The number of times PCEA and tenoxicam were 
      administered and the occurrence of adverse events (AEs) were also recorded. 
      RESULTS: Sixty patients (34 men, 26 women; mean [SD] age, 75.96 [4.25] years; 
      mean [SD] weight, 74.13 [10.62] kg) were included in the study. VAS scores were 
      significantly lower in the dexmedetomidine group compared with the control group 
      at hours 1, 2, and 12 (VAS [hour 1]: 2.8 [0.4], P < 0.001; VAS [hour 2]: 2.7 
      [0.5], P < 0.001; and VAS [hour 12]: 0.9 [0.7], P 0.044). The mean number of 
      administrations of fentanyl via PCEA was significantly greater in the control 
      group compared with the dexmedetomidine group (2.20 vs 6.63 times; P < 0.001). 
      The mean number of administrations of tenoxicam was significantly lower in the 
      treatment group than the control group (0.27 vs 1.07 times; P < 0.001). In the 
      control group, the decreases in sedation at 0, 8, 12, 16, and 20 hours were 
      significant compared with baseline (P = 0.024, P = 0.001, P = 0.020, P < 0.001, 
      and P = 0.005, respectively). Mean HR, SBR and AEs (eg, bradycardia [HR <60 
      beats/min], respiratory depression [respiratory rate <8 breaths/min], hypotension 
      \SBP <90 mm Hg], oversedation, hypoxia, and hypercapnia) decreased significantly 
      in the dexmedetomidine group (all, P < 0.05). Significantly more patients in the 
      dexmedetomidine group rated their satisfaction with postoperative pain control as 
      excellent compared with the control group (12 vs 6 patients; P = 0.014). 
      CONCLUSION: Intravenous dexmedetomidine was effective and generally well 
      tolerated as an analgesic adjunct to epidural low-dose bupivacaine infusion for 
      pain treatment, with lower need for opioids after abdominal surgery in these 
      elderly intensive care patients than in the control group.
FAU - Akin, Sule
AU  - Akin S
AD  - Anesthesiology and Reanimation Department, Baskent University School of Medicine, 
      Adana, Turkey.
FAU - Aribogan, Anis
AU  - Aribogan A
AD  - Anesthesiology and Reanimation Department, Baskent University School of Medicine, 
      Adana, Turkey.
FAU - Arslan, Gulnaz
AU  - Arslan G
AD  - Anesthesiology and Reanimation Department, Baskent University School of Medicine, 
      Adana, Turkey.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Curr Ther Res Clin Exp
JT  - Current therapeutic research, clinical and experimental
JID - 0372621
PMC - PMC3969974
OTO - NOTNLM
OT  - dexmedetomidine
OT  - elderly patients
OT  - epidural analgesia
OT  - postoperative analgesia
EDAT- 2008/02/01 00:00
MHDA- 2008/02/01 00:01
PMCR- 2008/02/01
CRDT- 2014/04/03 06:00
PHST- 2007/12/10 00:00 [accepted]
PHST- 2014/04/03 06:00 [entrez]
PHST- 2008/02/01 00:00 [pubmed]
PHST- 2008/02/01 00:01 [medline]
PHST- 2008/02/01 00:00 [pmc-release]
AID - S0011-393X(08)00016-7 [pii]
AID - 10.1016/j.curtheres.2008.02.001 [doi]
PST - ppublish
SO  - Curr Ther Res Clin Exp. 2008 Feb;69(1):16-28. doi: 
      10.1016/j.curtheres.2008.02.001.