The effect of two different dexmedetomidine doses on the prevention of nausea and vomiting in discectomy surgery under spinal anesthesia

Authors

1 Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Considering the preventative effect of various medications on such complications after surgery, the present study evaluated the effect of two different dexmedetomidine doses on the prevention of nausea and vomiting in discectomy surgery.
Materials and Methods: The present controlled, double-blind clinical trial was performed on 135 patients that were candidates for discectomy surgery under spinal anesthesia, which were randomly allocated into three groups. Two different dexmedetomidine doses of 0.2 and 0.5 mcg/kg/h were intravenously administered using an infusion pump for 10 min in the first (DEX-0.2 group) and second (DEX-0.5 group) groups, respectively, with the third placebo group being used as a control group. Hemodynamic parameters, the severity of nausea and vomiting, and the incidence of complications were evaluated and recorded up to 24 h after surgery.
Results: The results of the present study revealed that, 20 min after the intervention, the severity of nausea and vomiting in the control group (with the mean of 1.95 ± 1.58) was significantly higher than that of the DEX-0.2 and DEX-0.5 groups with the means of 1.52 ± 1.11 and 1.27 ± 0.99, respectively (P = 0.010). In addition, no significant difference was found between the two dexmedetomidine doses in terms of the severity of nausea and vomiting (P > 0.05).
Conclusion: According to the results of the present study, a low dose of dexmedetomidine may be a more preferable choice as a preventive drug in the incidence of nausea and vomiting in discectomy surgery due to its lower complications, further reduction of nausea and vomiting, and more desirable hemodynamic stability.

Keywords

1.
Ran J, Hu Y, Zheng Z, Zhu T, Zheng H, Jing Y, et al. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: A meta-analysis of comparative studies. PLoS One 2015;10:e0121816.  Back to cited text no. 1
    
2.
Vural C, Yorukoglu D. Comparison of patient satisfaction and cost in spinal and general anesthesia for lumbar disc surgery. Turk Neurosurg 2014;24:380-4.  Back to cited text no. 2
    
3.
Chou R, Atlas S. Subacute and chronic low back pain: Nonsurgical interventional treatment. SOMEPOMED Website http://somepomed.org/articulos/contents/mobipreview. htm. 2016;36:37104.  Back to cited text no. 3
    
4.
Brown MJ, Pasternak JJ, Crowley M. Anesthesia for Elective Spine Surgery in Adults. Massachusetts: Uptodate; 2018.  Back to cited text no. 4
    
5.
Meng T, Zhong Z, Meng L. Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: A systematic review and meta-analysis of randomised, controlled trials. Anaesthesia 2017;72:391-401.  Back to cited text no. 5
    
6.
Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 2002;27:722-31.  Back to cited text no. 6
    
7.
Chen X, Chamoli U, Vargas Castillo J, Ramakrishna VA, Diwan AD. Complication rates of different discectomy techniques for symptomatic lumbar disc herniation: A systematic review and meta-analysis. Eur Spine J 2020;29:1752-70.  Back to cited text no. 7
    
8.
Peng K, Liu HY, Liu SL, Ji FH. Dexmedetomidine-fentanyl compared with midazolam-fentanyl for conscious sedation in patients undergoing lumbar disc surgery. Clin Ther 2016;38:192-201.e2.  Back to cited text no. 8
    
9.
Finsterwald M, Muster M, Farshad M, Saporito A, Brada M, Aguirre JA. Spinal versus general anesthesia for lumbar spine surgery in high risk patients: Perioperative hemodynamic stability, complications and costs. J Clin Anesth 2018;46:3-7.  Back to cited text no. 9
    
10.
Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's Anesthesia E-Book. Amsterdam: Elsevier Health Sciences; 2014.  Back to cited text no. 10
    
11.
Jin S, Liang DD, Chen C, Zhang M, Wang J. Dexmedetomidine prevent postoperative nausea and vomiting on patients during general anesthesia: A PRISMA-compliant meta analysis of randomized controlled trials. Medicine (Baltimore) 2017;96:e5770.  Back to cited text no. 11
    
12.
Son J, Yoon H. Factors affecting postoperative nausea and vomiting in surgical patients. J Perianesth Nurs 2018;33:461-70.  Back to cited text no. 12
    
13.
Jain V, Chaturvedi A, Pandia MP, Bithal PK. Effect of dexmedetomidine on recovery profile of patients undergoing anterior cervical discectomy and fusion. J Anaesthesiol Clin Pharmacol 2019;35:92-8.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Hassani V, Farhadi M, Mohseni M, Safaeian R, Nikoobakht N, Kashani SS, et al. Comparing the efficacy of dexmedetomidine versus fentanyl and midazolam during awake fiberoptic intubation. Arch Anesthesiol Crit Care 2018;4:538-41.  Back to cited text no. 14
    
15.
Yuan F, Fu H, Yang P, Sun K, Wu S, Lv M, et al. Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study. Exp Ther Med 2016;12:506-12.  Back to cited text no. 15
    
16.
Botros JM, Mahmoud AM, Ragab SG, Ahmed MA, Roushdy HM, Yassin HM, et al. Comparative study between dexmedetomidine and ondansteron for prevention of post spinal shivering. A randomized controlled trial. BMC Anesthesiol 2018;18:179.  Back to cited text no. 16
    
17.
Jebaraj B, Ramachandran R, Rewari V, Trikha A, Chandralekha, Kumar R, et al. Feasibility of dexmedetomidine as sole analgesic agent during robotic urological surgery: A pilot study. J Anaesthesiol Clin Pharmacol 2017;33:187-92.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Liu H, Zhou C, Ji J. Effects of using different dose of dexmedetomidine during tracheal extubation for patients with parotidectomy after general anesthesia. Shanghai Kou Qiang Yi Xue 2016;25:368-72.  Back to cited text no. 18
    
19.
Panchgar V, Shetti AN, Sunitha HB, Dhulkhed VK, Nadkarni AV. The effectiveness of intravenous dexmedetomidine on perioperative hemodynamics, analgesic requirement, and side effects profile in patients undergoing laparoscopic surgery under general anesthesia. Anesth Essays Res 2017;11:72-7.  Back to cited text no. 19
[PUBMED]  [Full text]  
20.
Bojaraaj DR, Senthilkumar S, Vijayaragavan S, Gnanavelrajan A. Effect of intravenous use of dexmedetomidine on anesthetic requirements in patients undergoing elective spine surgery: A double blinded randomized controlled trail. Int J Sci Study 2016;4:251-5.  Back to cited text no. 20
    
21.
Hoy SM, Keating GM. Dexmedetomidine. Drugs 2011;71:1481-501.  Back to cited text no. 21
    
22.
Tobias JD. Bradycardia during dexmedetomidine and therapeutic hypothermia. J Intensive Care Med 2008;23:403-8.  Back to cited text no. 22