J Korean Med Sci.  2016 Sep;31(9):1485-1490. 10.3346/jkms.2016.31.9.1485.

Comparison of an Intraoperative Infusion of Dexmedetomidine, Fentanyl, and Remifentanil on Perioperative Hemodynamics, Sedation Quality, and Postoperative Pain Control

• Choi JW
• Joo JD
• Kim DW
• In JH
• Kwon SY
• Seo K
• Han D
• Cheon GY
• Jung HS

• KMID: 2468284
• DOI: http://doi.org/10.3346/jkms.2016.31.9.1485

Abstract

We aimed to compare fentanyl, remifentanil and dexmedetomidine with respect to hemodynamic stability, postoperative pain control and achievement of sedation at the postanesthetic care unit (PACU). In this randomized double-blind study, 90 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive fentanyl (1.0 µg/kg) over 1 minute followed by a 0.4 µg/kg/hr infusion (FK group, n = 30), or remifentanil (1.0 µg/kg) over 1 minute followed by a 0.08 µg/kg/min infusion (RK group, n = 30), or dexmedetomidine (1 µg/kg) over 10 minutes followed by a 0.5 µg/kg/hr infusion (DK group, n = 30) initiating at the end of main procedures of the operation to the time in the PACU. A single dose of intravenous ketorolac (30 mg) was given to all patients at the end of surgery. We respectively evaluated the pain VAS scores, the modified OAA/S scores, the BIS, the vital signs and the perioperative side effects to compare the efficacy of fentanyl, remifentanil and dexmedetomidine. Compared with other groups, the modified OAA/S scores were significantly lower in DK group at 0, 5 and 10 minutes after arrival at the PACU (P < 0.05), whereas the pain VAS and BIS were not significantly different from other groups. The blood pressure and heart rate in the DK group were significantly lower than those of other groups at the PACU (P < 0.05). DK group, at sedative doses, had the better postoperative hemodynamic stability than RK group or FK group and demonstrated a similar effect of pain control as RK group and FK group with patient awareness during sedation in the PACU. (World Health Organization registry, KCT0001524).

Keyword

Dexmedetomidine; Fentanyl; Remifentanil; Surgery; Pain Control; Hemodynamic Stability

MeSH Terms

Adolescent
Adult
Analgesics, Opioid/*administration & dosage/adverse effects
Blood Pressure
Dexmedetomidine/*administration & dosage/adverse effects
Double-Blind Method
Female
Fentanyl/*administration & dosage/adverse effects
Heart Rate
Hemodynamics/physiology
Humans
Hypotension/etiology
Laparoscopy
Male
Middle Aged
Nausea/etiology
Pain Management
Pain, Postoperative/*drug therapy
Piperidines/*administration & dosage/adverse effects
Young Adult
Analgesics, Opioid
Piperidines
Dexmedetomidine
Remifentanil
Fentanyl

Figure

• 

  Fig. 1 Flow diagram of progress through the study in Comparison of an intraoperative infusion of dexmedetomidine, fentanyl and remifentanil on perioperative hemodynamics, sedation quality and postoperative pain control.

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  Fig. 2 Changes in (A) modified observer's assessment of alertness /sedation (OAA/S) scores and (B) pain visual analogue scale (VAS) scores for the three groups. FK group, fentanyl-ketorolac group; RK group, remifentanil-ketorolac group; DK group, dexmedetomidine-ketorolac group. B, arrival at operation; R0, arrival at recovery room, R5, 5 minutes after arrival at recovery room; R10, 10 minutes after arrival at recovery room; R20, 20 minutes after arrival at recovery room; R30, 30 minutes after arrival at recovery room. *DK group Indicates significantly different than other groups (P < 0.05).

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  Fig. 3 Changes in bispectral index (BIS) for the three groups. FK group, fentanyl-ketorolac group. RK group, remifentanil-ketorolac group; DK group, dexmedetomidine-ketorolac group. t0, before induction time; t1, after induction time; t2, after incision time; t3, operation 15 minutes; t4, operation 30 minutes; t5, operation 60 minutes: t6, operation 75 minutes; t7, operation 80 minutes; t8, operation 85 minutes; t9, operation 90 minutes; t10-Rec-0, arrival at recovery room; t11-Rec-05, 5 minutes after arrival at recovery room; t12-Rec-10, 10 minutes after arrival at recovery room; t13-Rec-15, 15 minutes after arrival at recovery room; t14-Rec-20, 20 minutes after arrival at recovery room; t15-Rec-25, 25 minutes after arrival at recovery room; t16-Rec-30, 30 minutes after arrival at recovery room.

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  Fig. 4 Changes in (A) blood pressure and (B) heart rate for the three groups. FK group, fentanyl-ketorolac group; RK group: remifentanil-ketorolac group, DK group: dexmedetomidine-ketorolac group. t0, before induction time; t1, after induction time; t2, after incision time; t3, operation 15 minutes; t4, operation 30 minutes; t5, operation 60 minutes: t6, operation 75 minutes; t7, operation 80 minutes; t8, operation 85 minutes; t9, operation 90 minutes; t10-Rec-0, arrival at recovery room; t11-Rec-05, 5 minutes after arrival at recovery room; t12-Rec-10, 10 minutes after arrival at recovery room; t13-Rec-15, 15 minutes after arrival at recovery room; t14-Rec-20, 20 minutes after arrival at recovery room; t15-Rec-25, 25 minutes after arrival at recovery room; t16-rec-30, 30 minutes after arrival at recovery room. *DK group indicates significantly lower than other groups for systolic blood pressure (P < 0.05); †DK group indicates significantly lower than other groups for diastolic blood pressure (P < 0.05); ‡DK group indicates significantly lower than other groups for heart rate (P < 0.05).

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