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Abstract
Pediatric craniofacial reconstruction surgery is associated with significant perioperative analgesic requirements. As dexmedetomidine mediates central nervous system sympathetic activity and pain modulation, its intraoperative use could be beneficial in craniofacial surgery. We hypothesized that intraoperative administration of dexmedetomidine in children undergoing craniofacial reconstructive surgery would result in reduced opioid requirements, pain, sedation scores, and opioid-induced side effects compared to patients who did not receive dexmedetomidine. All patients who underwent craniofacial reconstructive surgery at our institution from July 2013 to June 2017 were retrospectively evaluated. The primary outcome measure was mean postoperative morphine equivalent requirements. Secondary outcome measures included incidence of opioid-related side effects, pain scores, and hospital length of stay. Thirty-nine patients received dexmedetomidine intraoperatively while 41 patients did not. There was no difference in postoperative opioid requirements or pain scores between the two cohorts. However, patients who received higher doses of dexmedetomidine (4.7 mcg/kg) intraoperatively exhibited significantly lower rescue medication requirements for nausea and vomiting postoperatively. Contrary to the hypothesis, dexmedetomidine was not associated with reduced postoperative opioid requirements or pain scores in children undergoing craniofacial reconstructive surgery. However, our findings do suggest that dexmedetomidine may be beneficial in reducing side effects such as postoperative nausea and vomiting. A randomized controlled trial would be necessary to verify these findings.
Highlights
Postoperative pain is a common challenge in the daily practice of anesthesia, and in many cases, continues to be inadequately managed
With each increase in dexmedetomidine by one unit, the need for ondansetron decreases by the absolute value of the coefficient; * All patients who received dexmedetomidine had zero doses of diphenhydramine or naloxone. This preliminary study suggests that intraoperative dexmedetomidine use during craniofacial reconstructive surgery is not associated with improved postoperative pain scores or reduced perioperative opioid requirements
Most of the pediatric data for postoperative nausea and vomiting are in children who are at least 3 years of age [17]
Summary
Postoperative pain is a common challenge in the daily practice of anesthesia, and in many cases, continues to be inadequately managed. This is true of pain in children due to difficulties with pain assessment and concerns related to side effects of opioids [1]. Children 2020, 7, 68 adopt a multimodal approach to perioperative pain control using non-opioid medications such as non-steroidal anti-inflammatory drugs, acetaminophen, local anesthetics, and alpha-2 receptor agonist as adjuncts [4]. Dexmedetomidine is a highly selective alpha-2 receptor agonist that mediates central nervous system sympathetic activity and pain modulation, in the spinal cord dorsal root ganglia [5]
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