Percedex.pmd

Use of Dexmedetomidine as an Adjunct to Pain Control Following OPCAB: Jeffrey L. Horswell MD, Michael J. Mack MD, Donna A Bachand RN PhD, Luis Michelsen MD, Syma L. Prince RN BSN, Cardiopulmonary Research Science and Technology Institute, Dallas Texas Objectives
Preoperative Characteristics by Treatment Group
Postoperative Complications by Treatment Group
Risk Factor
Treatment Group
Control Group
Complication
Treatment
Group N (%)
Group N (%)
Determine whether use of dexmedetomidine leads to improved clinical outcomes in immediately extubated, post-operative off-pump coronary artery bypass (OPCAB) patients Patients and Methods
• 24 patients were prospectively randomized in a double-blind fashion and scheduled for elective/urgent No difference in postoperative complications by treatment group • All caregivers were blinded to treatment arm.
Limitations
• Patients who were previously selected for epidural analgesia or who had elevated serum creatinine • By chance, all women were in the control group • Fifteen minutes prior to extubation, patients were randomly selected for one of two groups: No difference in preoperative risk factors by treatment group • Group 1 (n=12) received an 18 hour infusion of dexmedetomidine 0.2 to 0.7 µg/kg/hr Conclusion
• Group 2 (n=12) received an 18 hour infusion of normal saline.
• Dexmedetomidine is a safe and effective adjunct to post-operative analgesia, reducing narcotic usage, maintaining • All patients received a standard anesthetic.
hemodynamic stability, and facilitating earlier post-operative mobilization.
• Mean narcotic use was 2.1 times greater in the placebo group (23.5 ± 20.7 mg) compared to the treatment Induction
Maintenance
group (11.4 ± 6.3 mg; p=0.03) Graph 1 ABSTRACT: Use of Dexmedetomidine as an Adjunct to Pain Control Following OPCAB: A Randomized, Double-Blind Study
Jeffrey L. Horswell MD, Michael J. Mack MD, Donna A Bachand RN PhD, Luis Michelsen MD, Tina Worley RN BSN CCRC Objectives: The purpose of this study was to determine whether use of dexmedetomidine leads to improved clinical outcomes in
immediately extubated, post-operative off-pump coronary artery bypass (OPCAB) patients.
• All patients were extubated in the operating room.
Patients and Methods: 24 patients scheduled for elective OPCAB consented to participate in the study. Patients who were
previously selected for epidural analgesia or who had elevated serum creatinine levels were excluded. Fifteen minutes prior to
• For post-operative pain management, patients received ketorolac 30 mg followed by 15 mg IV every 6 extubation, patients were prospectively randomized in a double-blind fashion into one of two groups: Group 1 (n=12) received an hours for 6 doses. 15 minutes prior to extubation, the study infusion was begun at a dosage of 18 hour infusion of dexmedetomidine 0.2 to 0.7 µg/kg/hr. Group 2 (n=12) received an 18 hour infusion of normal saline. All patients received a standard anesthetic consisting of propofol, sufentanil, vecuronim, and desflurane. Post-operative pain wasmanaged with ketorolac and morphine. Total morphine use was recorded. Hemodynamic monitoring, incentive spirometryvolumes, visual analog scale pain ratings, activity, and anxiety levels were recorded every 2 hours for 18 hours post-operatively.
• The study drug was adjusted within the range of 0.2 to 0.7 µg/kg/hr to achieve a visual analog scale Results are reported as mean ± standard deviation. Student’s t-test was used to test the difference in means between the two (VAS) value < 40 on a 100 mm scale. Breakthrough pain was treated with morphine 2 mg every 5 • Time to post-operative mobilization was reduced significantly in the treatment group ( 292 ± 89 min) groups. Paired t-tests were used to evaluate changes across time intervals.
compared to the control group (564 ± 361 min; p=0.03). Graph 2 Results: Mean narcotic use was 2.1 times greater in the placebo group (23.5 ± 20.7 mg) compared to the treatment group (11.4 ±
• Clinical monitoring recorded every 2 hours for 18 hours post-operatively • Time to achieve adequate pain control (VAS rating <35) was more rapid in the treatment group (6 hours vs. 8 6.3 mg; p=.03). Time to achieving adequate pain control (VAS rating <35) was more rapid in the treatment group (6 hours vs. 8 hours). Although morphine doses were available on demand to all patients, those in the treatment group hours). Although morphine doses were available on demand to all patients, those in the treatment group reported less pain at all reported less pain at all time points.
time points. Patients in the treatment group were out of bed earlier (564 ± 361 vs. 292 ± 89 minutes; p=.03). There were no significant changes in heart rate, blood pressure, pulmonary artery pressure, central venous pressure, cardiac output, or systemic oxygen saturation in either group. When hemodynamic data were analyzed by subject, no significant changes could be detected.
Conclusion: Dexmedetomidine provides effective post-operative pain control without untoward hemodynamic changes in
• Results are reported as mean ± standard deviation. Student’s t-test was used to test the difference in immediately extubated OPCAB patients. Superior pain control can be achieved with minimal doses of narcotics.
means between the two groups. Paired t-tests were used to evaluate changes across time intervals.
Demographics of Patient Population
Treatment
Patients
• There were no significant changes in heart rate, blood pressure, pulmonary artery pressure, central venous pressure, cardiac output, or systemic oxygen saturation in either group. When the hemodynamic data was analyzed by subject, no significant changes could be detected.
• Sub-group analysis by diabetes status showed no significant effect on drug use or VAS scores.

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