Addition of Dexmedetomidine to the Anesthesia Regimen Attenuates Pain and Improves Early Recovery After Esophageal Endoscopic Submucosal Dissection: A Randomized Controlled Trial.

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2024-10-11 eCollection Date: 2024-01-01 DOI:10.2147/DDDT.S475749

Xin Luo, Hai-Jun Hou, Pei-Shan Chen, Xin-Lu Chang, Yang Li, Li-Xin An, Fu-Kun Liu, Fu-Shan Xue

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Abstract

Objective: Postoperative pain is a common yet often underestimated complication following esophageal endoscopic submucosal dissection (ESD), with limited strategies for effective management. This prospective, double-blind, randomized controlled trial assessed the effects of adding dexmedetomidine (DEX) to the anesthesia regimen on postoperative pain and early recovery in patients undergoing esophageal ESD.

Methods: In total, 60 patients scheduled for elective esophageal ESD under general anesthesia were randomly assigned to the DEX or control group. The DEX group received an intravenous loading dose of DEX at 1 μg/kg for 10 min, followed by a continuous intravenous infusion of 0.6 µg/kg/h, which was stopped 30 min before the end of the procedure. The control group received normal saline as a placebo. The study's primary outcome was the incidence of moderate-to-severe postoperative pain. Secondary outcomes included postoperative pain scores, hemodynamic parameters, the occurrence of postoperative nausea and vomiting (PONV), patient satisfaction, and lengths of stay in the post-anesthesia care unit (PACU) and hospital.

Results: The incidence of moderate-to-severe postoperative pain in the DEX group was significantly lower than that in the control group (absolute difference: -33.4%; OR: 0.250; 95% CI: 0.085-0.731, P = 0.01). Pain scores at 1 h postoperatively (0.5[2.0] vs 3.0[1.3], P = 0.003) were significantly lower in the DEX group. Additionally, morphine dosage in the PACU (0[0] vs 1.0[2.0] P = 0.004) was significantly reduced in the DEX group compared with the control group. In the DEX group, the incidence and severity of PONV were significantly decreased and the length of PACU stay was shorter than in the control group (P < 0.01). However, the rates of intraoperative hypotension, tachycardia, and bradycardia were similar between the two groups. Patient satisfaction and length of hospital stay were also comparable.

Conclusion: Adding DEX to the anesthesia regimen for esophageal ESD significantly attenuates postoperative pain and improves early recovery outcomes.

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在麻醉方案中加入右美托咪定可减轻疼痛并改善食管内镜粘膜下剥离术后的早期恢复：随机对照试验。

目的：术后疼痛是食管内镜黏膜下剥离术（ESD）后常见的并发症，但往往被低估，有效治疗策略有限。这项前瞻性、双盲、随机对照试验评估了在麻醉方案中加入右美托咪定（DEX）对食管 ESD 患者术后疼痛和早期恢复的影响：共有60名患者计划在全身麻醉下进行食管ESD手术，他们被随机分配到DEX组或对照组。DEX组在10分钟内静脉注射1微克/千克的DEX负荷剂量，然后持续静脉输注0.6微克/千克/小时，在手术结束前30分钟停止。对照组接受生理盐水作为安慰剂。研究的主要结果是中度至重度术后疼痛的发生率。次要结果包括术后疼痛评分、血液动力学参数、术后恶心和呕吐（PONV）发生率、患者满意度、麻醉后护理病房（PACU）和住院时间：DEX组术后中重度疼痛的发生率明显低于对照组（绝对差异：-33.4%；OR：0.250；95% CI：0.085-0.731，P = 0.01）。术后 1 小时的疼痛评分（0.5[2.0] vs 3.0[1.3]，P = 0.003）在 DEX 组明显降低。此外，与对照组相比，DEX 组在 PACU 的吗啡用量（0[0] vs 1.0[2.0] P = 0.004）明显减少。与对照组相比，DEX 组 PONV 的发生率和严重程度明显降低，PACU 滞留时间也更短（P 0.01）。不过，两组术中低血压、心动过速和心动过缓的发生率相似。患者满意度和住院时间也相当：结论：在食道ESD麻醉方案中加入DEX可显著减轻术后疼痛，改善早期恢复效果。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.