Abstract
Introduction:Although there are multiple analgesia techniques, opioids remain the most widely used drug for pain control. Postoperative Nausea and Vomiting (PONV), sleepiness, respiratory, and gastrointestinal disorder are common complications of postoperative opioid use, which makes the decrease in opioid demand, through combination with non-opioid agents, desirable. Dexmedetomidine (DEX) is an alpha2-adrenergic agonist with sedative and anxiolytic effects. Recently, some studies proved the evidence of its notable opioid-sparing effect. Furthermore DEX, compared to opioids, seems to have the advantage of not inhibiting spontaneous breathing.Aim:This systematic review protocol aims to define the analgesic effect of perioperative DEX infusion and the cumulative opioid consumption of patients undergoing general anesthesia.Methods:The review will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocols (PRISMA- P) statement and the Cochrane recommendations for Systematic Reviews of Interventions.Results:The primary outcomes will be 1) The effect of DEX infusion, on pain control, compared to placebo or other treatments and 2) The opioid-sparing effect of DEX infusion compared to placebo or other treatments. The secondary outcome will be a) Respiratory depression, b) Hypotension requiring fluid infusion and/or amine, c) Bradycardia requiring vasoactive drugs, d) Needing of prolonged hospital stay, e) PONV and gastrointestinal disorders.Conclusion:A sub-analysis is planned for i) The type of surgery performed, ii) Patient’s gender, iii) Patients age. If possible, a meta- analysis (including sub-analysis and sensitivity analysis for all assessed outcomes) will be performed. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be followed to create a Summary of Findings.The Registration Number for this Systematic Review is CRD42018086687.
Highlights
There are multiple analgesia techniques, opioids remain the most widely used drug for pain control
The primary outcomes will be 1) The effect of DEX infusion, on pain control, compared to placebo or other treatments and 2) The opioid-sparing effect of DEX infusion compared to placebo or other treatments
There is a great emphasis on limiting the use of opioids; on April 25th, the Food and Drug Administration (FDA) launched its newest campaign “Reduce the Risk” against the epidemy of opioid use [21]
Summary
There are multiple analgesia techniques, opioids remain the most widely used drug for pain control. Dexmedetomidine (DEX) is an alpha2-adrenergic agonist with sedative and anxiolytic effects. Some studies proved the evidence of its notable opioid-sparing effect. 140 The Open Anesthesia Journal, 2019, Volume 13 the decrease in opioid demand, through combination with nonopioid agents, desirable. Some authors suggest that for the abdominal surgery, related itself with the risk of ileus, opioids should be used only when non-opioid drugs provide insufficient analgesia [2]. The action on alpha2-adrenergic receptors in the locus coeruleus explains the sedative and anxiolytic effects of DEX, decreasing the sympathetic tone. Chrysostomou et al described that DEX administration gives analgesia and sedation showing benzodiazepine and opioid-sparing effect when used with anesthetic drugs [4]. Some studies proved the evidence of a notable opioid-sparing effect of DEX [5 - 7]. DEX, compared to opioids, seems to have the advantage of not inhibiting spontaneous breathing [8, 9]
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