Preet Mohinder Singh1, Rajesh Panwar2, Anuradha Borle3, Jan P Mulier4, Ashish Sinha5, Basavana Goudra6. 1. Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India. Electronic address: Preetrajpal@gmail.com. 2. Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India. 4. Department of Anesthesiology, Intensive Care and Reanimation, AZ Sint Jan Brugge-Oostende, Bruges, Belgium. 5. Department of Anesthesiology, Temple University, Philadelphia, PA, USA. 6. Hospital of the University of Pennsylvania and Perleman School of Medicine, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Opioid-sparing analgesia for bariatric surgery in morbidly obese can potentially prevent catastrophic airway complications. Our meta-analysis attempts to consolidate the evidence on dexmedetomidine evaluating its analgesic and safety profile. METHODS: Trails comparing perioperative dexmedetomidine infusion to conventional analgesic regimens for bariatric surgery were searched. Comparisons were made for 24-hour and postanesthesia care unit (PACU) morphine consumed, PACU pain scores, postoperative nausea and vomiting pain scores, and heartrate. Meta-regression was performed for length of stay to evaluate various analgesic control subgroups. RESULTS: Six trials were included in the final analysis. Dexmedetomidine infusion (reported in 5 intraoperative subgroups and 2 postoperative subgroups) decreased 24-hour morphine by 18.13±6.11 mg (random effects: P<.001, I2 = 95.48%). Despite the small number of included studies, the sample size for avoiding a false positive result was adequate as the trial sequential analysis found the present sample size (362) to be well past the required "sample size" (n = 312) for 85% power. Meta-regression for infusion dose on morphine consumption difference found a predictability of 49% (coefficient = 39.93, random-effects, Tau2 = 396.08), and predictability of the model improved to 68% on inclusion of time of initiation of infusion. The dexmedetomidine group had lower PACU morphine consumption (by 6.91±1.19, I2 = 34.37%), lower pain scores (scale of 0-10±2.27, I2 = 88.14%), lower postoperative nausea and vomiting incidence (odds ratio =±0.26, I2 = 0%), and lower heart rate (73.25 versus. 83.50) (mean difference =±10.15 I2 = 94.04%). No adverse events were reported across trials. CONCLUSION: Perioperative dexmedetomidine infusion in obese patients undergoing bariatric surgery is a promising and safe alternative. Both intraoperative or postoperative infusions lead to significant opioid sparing in early and extend postoperative recovery phase. Morbidly obese patients receiving perioperative dexmedetomidine infusions have overall better pain control and lower incidence of postoperative nausea-vomiting. All the aforementioned merits come with a stable hemodynamic profile and without any reported major adverse events.
BACKGROUND: Opioid-sparing analgesia for bariatric surgery in morbidly obese can potentially prevent catastrophic airway complications. Our meta-analysis attempts to consolidate the evidence on dexmedetomidine evaluating its analgesic and safety profile. METHODS: Trails comparing perioperative dexmedetomidine infusion to conventional analgesic regimens for bariatric surgery were searched. Comparisons were made for 24-hour and postanesthesia care unit (PACU) morphine consumed, PACUpain scores, postoperative nausea and vomiting pain scores, and heartrate. Meta-regression was performed for length of stay to evaluate various analgesic control subgroups. RESULTS: Six trials were included in the final analysis. Dexmedetomidine infusion (reported in 5 intraoperative subgroups and 2 postoperative subgroups) decreased 24-hour morphine by 18.13±6.11 mg (random effects: P<.001, I2 = 95.48%). Despite the small number of included studies, the sample size for avoiding a false positive result was adequate as the trial sequential analysis found the present sample size (362) to be well past the required "sample size" (n = 312) for 85% power. Meta-regression for infusion dose on morphine consumption difference found a predictability of 49% (coefficient = 39.93, random-effects, Tau2 = 396.08), and predictability of the model improved to 68% on inclusion of time of initiation of infusion. The dexmedetomidine group had lower PACUmorphine consumption (by 6.91±1.19, I2 = 34.37%), lower pain scores (scale of 0-10±2.27, I2 = 88.14%), lower postoperative nausea and vomiting incidence (odds ratio =±0.26, I2 = 0%), and lower heart rate (73.25 versus. 83.50) (mean difference =±10.15 I2 = 94.04%). No adverse events were reported across trials. CONCLUSION: Perioperative dexmedetomidine infusion in obesepatients undergoing bariatric surgery is a promising and safe alternative. Both intraoperative or postoperative infusions lead to significant opioid sparing in early and extend postoperative recovery phase. Morbidly obesepatients receiving perioperative dexmedetomidine infusions have overall better pain control and lower incidence of postoperative nausea-vomiting. All the aforementioned merits come with a stable hemodynamic profile and without any reported major adverse events.
Authors: Mohamed Ali Mohamed Ali Chaouch; Mohamed Aziz Daghmouri; Marie-Christine Boutron; Jean-Marc Ferraz; Sofia Usai; Olivier Soubrane; Marc Beaussier; Guillaume Pourcher; Hani Oweira Journal: Ann Med Surg (Lond) Date: 2022-05-14
Authors: Alan David Kaye; David J Chernobylsky; Pankaj Thakur; Harish Siddaiah; Rachel J Kaye; Lauren K Eng; Monica W Harbell; Jared Lajaunie; Elyse M Cornett Journal: Curr Pain Headache Rep Date: 2020-04-02