Dexmedetomidine effective for pain control after knee, hip replacement surgery
China: Dexmedetomidine is an effective treatment for postoperative pain control and postoperative delirium in patients undergoing knee/hip replacement surgery, according to a recent review in the journal Medicine.
Arthroscopy, a minimally invasive surgical procedure on a joint, has been widely used for the treatment of knee and hip diseases. The procedure, although associated with less morbidity compared with open procedures, many patients still encounter moderate to severe pain. The postoperative pain, if not managed properly, can lead to delayed recovery, prolonged hospital stays, a greater consumption of healthcare resources and poor outcomes.
Dexmedetomidine is a highly selective, specific, and potent α2-adrenergic receptor agonist. Many studies have demonstrated that dexmedetomidine can significantly decrease pain scores and postoperative diclofenac sodium consumption and can improve the duration of the analgesic effect. Furthermore, it also decreases the incidence of postoperative delirium and postoperative nausea and vomiting (PONV). However, the safety and efficacy of dexmedetomidine therapy in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) is still debatable.
Yang Qi, Department of Orthopedics, First Hospital of Harbin, Harbin, China, and colleagues evaluated the safety and efficacy of dexmedetomidine in patients undergoing total knee and hip arthroplasty for postoperative pain control.
For the purpose, the researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) identified in systematic searches. 14 RCTs with a total of 1220 patients were included.
Key findings of the study include:
- Dexmedetomidine therapy was associated with significantly decreased pain scores 24 hours after surgery (WMD, −0.36;) compared with scores in the control group after total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- The rate of postoperative delirium was also markedly decreased with dexmedetomidine therapy (RR, 0.38).
- Compared with the control group, dexmedetomidine treatment was associated with a decreased risk of postoperative nausea and vomiting in patients undergoing TKA (RR, 0.34), and there was a similar risk of hypotension (RR, 1.03) regardless of whether patients underwent TKA or THA.
- The rate of bradycardia was significantly increased with dexmedetomidine treatment in those undergoing TKA (RR, 6.11).
"Dexmedetomidine therapy seems to be an effective treatment for pain control and postoperative delirium in patients undergoing TKA/THA. However, the incidence of bradycardia is markedly increased in patients undergoing TKA. Hence, much larger prospective clinical studies are warranted to confirm these findings," concluded the authors.