Comparison of the Efficacy of Dexmedetomidine plus Fentanyl Patient-controlled Analgesia with Fentanyl Patient-controlled Analgesia for Pain Control in Uterine Artery Embolization for Symptomatic Fibroid Tumors or Adenomyosis: A Prospective, Randomized Study

Kim SY, So Yeon Kim, Chul Ho Chang, Jong Seok Lee, Kim YJ, Yoon Jae Kim, Kim MD, Man Deuk Kim, Dong Woo Han
Journal of vascular and interventional radiology : JVIR · 2013 · vol. 24(6) , pp. 779–786 · doi:10.1016/j.jvir.2013.02.034 · PMID:23707085 · W2104491689
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This study found that dexmedetomidine infusion combined with fentanyl PCA reduced fentanyl consumption, pain scores, and nausea/vomiting after uterine artery embolization compared to fentanyl PCA alone.

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This prospective randomized study evaluated whether a peri-procedural dexmedetomidine infusion would reduce opioid use and opioid-related side effects in 50 patients undergoing uterine artery embolization for symptomatic leiomyomas or adenomyosis, all of whom received fentanyl-based intravenous PCA for 24 hours. Patients received either dexmedetomidine infusion (0.2 μg/kg/h starting 30 minutes before UAE, then 0.4 μg/kg/h for 6 hours post-procedure) or volume-matched normal saline in addition to the same fentanyl PCA regimen; outcomes included pain scores, fentanyl consumption, additional analgesic use, and side effects over 24 hours. Compared with saline, dexmedetomidine reduced PCA fentanyl consumption by 28% and was associated with lower pain scores and fewer patients needing additional analgesics in the first hour, as well as a lower incidence and severity of nausea and vomiting over 24 hours, without significant hemodynamic instability. This paper is centrally about adenomyosis and uterine artery embolization analgesia — it specifically includes adenomyosis as one of the studied indications and tests dexmedetomidine for pain control in that setting.

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Abstract

PurposeTo investigate whether dexmedetomidine infusion could reduce opioid consumption and opioid-related side effects after uterine artery embolization (UAE).Materials and methodsFifty patients undergoing UAE for symptomatic leiomyomas or adenomyosis were randomized into two groups. In 25 patients, dexmedetomidine infusion was started at 0.2 μg/kg/h at 30 minutes before the procedure, followed by 0.4 μg/kg/h for 6 hours after the procedure. In another 25 patients (control group), volume-matched normal saline solution was administered. Both groups received fentanyl-based intravenous patient-controlled analgesia (PCA; fentanyl 10 μg/h with a bolus dose of 20 μg) during the 24 hours after the procedure. Nonspherical polyvinyl alcohol particles were used. Pain scores, fentanyl consumption, need for additional analgesics, and side effects were assessed for 24 hours after UAE.ResultsCompared with the control group, patients in the dexmedetomidine group required 28% less PCA fentanyl during the 24 hours after UAE (P = .006). Numeric rating scale scores for pain (5.0±2.4 vs 7.0±2.2; P = .026) and the need for additional analgesics (two of 25 vs 17 of 25; P<.001) were lower in the dexmedetomidine group than in the control group during the first 1 hour after UAE. The incidence and severity of nausea and vomiting during the 24 hours after UAE were lower in the dexmedetomidine group than in the control group (P < .05).ConclusionsThe addition of dexmedetomidine infusion to fentanyl PCA provides better analgesia, fentanyl-sparing effect, and less nausea and vomiting, without significant hemodynamic instability.
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Materials and methods

Fifty patients undergoing UAE for symptomatic leiomyomas or adenomyosis were randomized into two groups. In 25 patients, dexmedetomidine infusion was started at 0.2 μg/kg/h at 30 minutes before the procedure, followed by 0.4 μg/kg/h for 6 hours after the procedure. In another 25 patients (control group), volume-matched normal saline solution was administered. Both groups received fentanyl-based intravenous patient-controlled analgesia (PCA; fentanyl 10 μg/h with a bolus dose of 20 μg) during the 24 hours after the procedure. Nonspherical polyvinyl alcohol particles were used. Pain scores, fentanyl consumption, need for additional analgesics, and side effects were assessed for 24 hours after UAE.

Results

Compared with the control group, patients in the dexmedetomidine group required 28% less PCA fentanyl during the 24 hours after UAE (P = .006). Numeric rating scale scores for pain (5.0±2.4 vs 7.0±2.2; P = .026) and the need for additional analgesics (two of 25 vs 17 of 25; P<.001) were lower in the dexmedetomidine group than in the control group during the first 1 hour after UAE. The incidence and severity of nausea and vomiting during the 24 hours after UAE were lower in the dexmedetomidine group than in the control group (P < .05).

Conclusions

The addition of dexmedetomidine infusion to fentanyl PCA provides better analgesia, fentanyl-sparing effect, and less nausea and vomiting, without significant hemodynamic instability. - Appears in Collections: - 1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers - Yonsei Authors - Kim, Man Deuk(김만득) https://orcid.org/0000-0002-3575-5847 Kim, So Yeon(김소연) https://orcid.org/0000-0001-5352-157X Lee, Jong Seok(이종석) https://orcid.org/0000-0002-7945-2530 Chang, Chul Ho(장철호) https://orcid.org/0000-0001-5647-8298 Han, Dong Woo(한동우) https://orcid.org/0000-0002-8757-663X Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Dexmedetomidine Fentanyl Leiomyoma Pain Pain Uterine Artery Embolization Uterine Neoplasms Adenomyosis Adenomyosis Adjuvants, Anesthesia Adjuvants, Anesthesia Analgesics, Non-Narcotic Analgesics, Non-Narcotic Chemoembolization, Therapeutic Chemoembolization, Therapeutic Dexmedetomidine Drug Therapy, Combination Female Fentanyl

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