Effects of Intraoperative Dexmedetomidine Infusion on Postoperative Pain after Craniotomy: A Narrative Review.

Nesjla Sofia Syrous,Eirik Søfteland,Ib Jammer,Terje Sundstrøm

doi:10.3390/brainsci11121636

Abstract

Craniotomy involves procedures with high incidences of postoperative pain. Dexmedetomidine, a highly selective a2-adrenoreceptor agonist, has been shown to be beneficial in neuroanaesthesia. The purpose of this narrative review was to assess the effect and safety of dexmedetomidine given intraoperatively during anaesthesia compared to placebo and demonstrate the effect on acute postoperative pain in adult patients undergoing craniotomy. Literature published from 1996 until 2021 were analysed through a search of PubMed, Medline and Embase. Randomised controlled trials investigating intraoperative administration of Dexmedetomidine with evaluation of postoperative pain were included. Medical Subject Headings terms and free-text words were used to identify articles related to the intraoperative use of Dexmedetomidine and postcraniotomy pain. Thirteen distinct randomized controlled trials with 882 recruited patients undergoing craniotomy were identified as eligible for final inclusion. Intraoperative administration of dexmedetomidine is associated with decreased postoperative pain and opioid consumption, and it assures haemodynamic stability. Dexmedetomidine is an efficacious adjunct in craniotomy in adults, showing benefits in reduction of postoperative pain and analgesic consumption. Dexmedetomidine also offers haemodynamic stability. However, widespread methodological heterogeneity of the papers prohibits a valid meta-analysis.

Highlights

Studies have reported that 40–84% of neurosurgical patients experience moderate to severe pain during the first postoperative days, despite liberal use of intraoperative opioids [1,2]
Acute postcraniotomy pain is predominantly located to the area of incision and involves pericranial muscle and soft tissue
Inadequate analgesia and pain after neurosurgery may cause a series of adverse events, such as agitation, hypertension, increased intracranial pressure and postoperative intracerebral haemorrhage

Summary

Introduction

Studies have reported that 40–84% of neurosurgical patients experience moderate to severe pain during the first postoperative days, despite liberal use of intraoperative opioids [1,2]. Pain is usually most pronounced during the first 48 h after surgery [3,4]. Inadequate analgesia and pain after neurosurgery may cause a series of adverse events, such as agitation, hypertension, increased intracranial pressure and postoperative intracerebral haemorrhage. This can prolong the hospital stay and, most importantly, increase patient morbidity and mortality [8,9]. Measures to avoid or to reduce the use of opioid analgesia are increasingly incorporated in the analgesic regimens

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Results

Conclusion