Dexmedetomidine decreases intraoperative fentanyl requirement

In the quest to enhance patient outcomes and reduce complications in bariatric surgery, Belal Nabil and colleagues have turned to the development of innovative anesthetic techniques. Among the candidates are ketamine and dexmedetomidine, both known for their perioperative analgesic properties. In a recent trial, investigators set out to determine whether the choice between ketamine and dexmedetomidine infusion would impact postoperative morphine consumption, a key factor in recovery.

The study involved a randomized sample of ninety patients, evenly distributed into three groups. The ketamine group received a bolus dose of ketamine (0.3 mg/kg) over 10 minutes, followed by a continuous infusion of the same drug (0.3 mg/kg/h). The dexmedetomidine group received a bolus dose of dexmedetomidine (0.5 mcg/kg) over 10 minutes, followed by a continuous infusion (0.5 mg/kg/h). The control group received a saline infusion. All infusions were administered until 10 minutes before the end of surgery.

The primary outcome of the study was the total morphine consumption, while secondary outcomes included intraoperative fentanyl requirement, time to extubation, postoperative nausea and vomiting (PONV), numerical rating scale (NRS) scores for pain, and modified observer's agitation/sedation scale (MOASS) scores.

The results of the trial yielded noteworthy findings. Compared to the ketamine group, patients in the dexmedetomidine group required less intraoperative fentanyl (160 ± 42 µg), had a shorter time to extubation (3 ± 1 minutes), and experienced improved MOASS and PONV scores. On the other hand, the ketamine group showed lower NRS pain scores and reduced morphine requirements (3 ± 3 mg) postoperatively.

The implications of these findings are significant. Dexmedetomidine infusion demonstrated efficacy in reducing the need for intraoperative fentanyl and hastening the extubation process, leading to smoother recoveries. Meanwhile, ketamine administration resulted in lower pain scores and decreased reliance on morphine for analgesia, offering a potential avenue for postoperative pain management.

This study highlights the potential benefits of incorporating dexmedetomidine and ketamine into the anesthetic regimen for bariatric surgery. By reducing the reliance on opioids and optimizing pain control, these novel techniques have the potential to enhance patient comfort, facilitate faster recoveries, and minimize the risk of opioid-related complications.

Source:

Khalil, B. N. M., Elderh, M. S. H., Khaja, M. A. R., El-Shaer, A. N., Ali, B. E.-D. E. H., & Taeimah, M. O. A. (2023). Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial. In BMC Anesthesiology (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12871-023-02059-3