Abstract
Background: Dexmedetomidine possesses sedative, sympatholytic, and opioid-sparing properties, but its impact on postoperative gastrointestinal function is controversial. Methods: This single-center, prospective, randomized study compared low-dose dexmedetomidine and placebo on gastrointestinal function recovery and inflammation after posterior lumbar spinal fusion. Sixty-six patients were randomized into two groups and received normal saline (control group) or dexmedetomidine (DEX group) during posterior lumbar fusion. Blood was taken at five timepoints to measure lipopolysaccharides, tumor necrosis factor-α, and C-reactive protein. The primary outcome was duration to first flatus. The secondary outcomes were inflammatory mediators and determination of correlations between perioperative factors and duration to first flatus. Results: Patients in DEX group showed significantly lower duration to first flatus (15.37 [13.35–17.38] vs 19.58 [17.31–21.86] h; p = 0.006) and overall sufentanil consumption (67.19 [63.78–70.62] vs 74.67 [69.96–79.30] μg; p = 0.011) than controls. Lipopolysaccharides, tumor necrosis factor-α, and C-reactive protein did not differ between the groups at any timepoint (all p > 0.05). Multiple linear regression modeling assessed the ability of independent variables to predict variance in duration to first flatus (adjusted R2 = 0.379, p = 0.000). In the model, age (β = 0.243, p = 0.003), gender (β = −3.718, p = 0.011), BMI (β = −0.913, p = 0.001), operative segments (β = −4.079, p = 0.028), and overall sufentanil consumption (β = 0.426, p = 0.000) contributed significantly. Conclusions: Thus, low-dose dexmedetomidine accelerates gastrointestinal function recovery after lumbar spinal fusion. The effect may be partially produced by opioid-sparing effects rather than inhibition of inflammation. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR1800018127.
Highlights
Patients undergoing lumber spinal surgery usually encounter postoperative transient gastrointestinal (GI) dysfunction due to prolonged bed rest
Lipopolysaccharides, tumor necrosis factor-a, and C-reactive protein did not differ between the groups at any timepoint
The effect may be partially produced by opioid-sparing effects rather than inhibition of inflammation
Summary
Patients undergoing lumber spinal surgery usually encounter postoperative transient gastrointestinal (GI) dysfunction due to prolonged bed rest. Potential mechanisms/factors leading to GI dysfunction may include activation of inhibitory sympathetic reflexes, systematic use of opioids, surgical trauma-induced inflammatory responses, and prolonged bed rest (Bauer and Boeckxstaens, 2004). This study employed a least recommended clinical dose of DEX to reduce the side effects and ensure safety in elderly patients. Based on the characteristics of DEX and the possible mechanisms underlying postoperative GI dysfunction, the present study assumed that administration of this low-dose DEX during lumbar spinal fusion surgery may accelerate postoperative GI function recovery and/or attenuate inflammation. This study compared low-dose dexmedetomidine and placebo on gastrointestinal function recovery and inflammatory mediators after posterior lumbar spinal fusion. Dexmedetomidine possesses sedative, sympatholytic, and opioid-sparing properties, but its impact on postoperative gastrointestinal function is controversial
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