Comparing the effects of Dexmedetomidine compared to intravenous remifentanil in controlling pain after lumbar spine surgery

Comparing the effects of Dexmedetomidine compared to intravenous remifentanil in controlling pain after lumbar spine surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparing the effects of Dexmedetomidine compared to intravenous remifentanil in controlling pain after lumbar spine surgery Maryam Mardani Hosseinabadi, Mahnaz Narimani Zamanabadi, Farshad Hassanzadeh Kiabi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8007817/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Postoperative pain is one of the common side effects and one of the important problems of modern anesthesia, which is also awkward for patients. Post-operative pain can cause many complications, so postoperative pain control should be a comprehensive approach. Anesthetic drugs, anesthesia method and type of surgery are effective in the amount of pain after the operation of the patient, and with some optimizations, the patient's pain can be reduced and controlled. Methods In this trial, 92 patients who were candidates for lumbar spine surgery were included in the study. Anesthesia was maintained in these patients with dexmedomidine or remifentanil, and patients' pain was measured and monitored at certain hours after the operation. Data comparison and analysis of two groups was done in SPSS16 software. Results In this study, data from 92 patients were analyzed in two groups: one receiving remifentanil and the other dexmedetomidine. According to the results, the highest mean pain scores were recorded two hours after surgery: the VAS score was 5.6 ± 1.5 in the remifentanil group and 3.5 ± 1.2 in the dexmedetomidine group. The RSAS score two hours after surgery was 2.8 ± 0.75 for the remifentanil group and 1.7 ± 0.6 for the dexmedetomidine group. The OPS score two hours after surgery was − 1.2 in the remifentanil group and − 0.58 in the dexmedetomidine group. Conclusion In examining the level of pain control in patients whose anesthesia was maintained in the two groups of dexmedetomidine and remifentanil, a significant difference was observed and dexmedetomiden group had less pain than remifentanil group. Trial registration The Ethics Committee of Alborz University of Medical Sciences granted ethical approval for our study protocol on April 11, 2024 (2024-04-11). The study was officially registered with the Iranian Clinical Trial Registry (IRCT20241030063548N1) on November 14, 2024. pain anesthesia remifentanil dexmedetomidine Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction In the past, the effects of anesthetic drugs on the depth of anesthesia could be assessed by observing vital signs such as heart rate, blood pressure, breathing pattern, and the presence or absence of motor activity ( 1 ). Although these measures are useful, the cardiopulmonary effects of anesthetics are generally considered side effects ( 2 ). However, in the absence of clinical signs of anesthesia—such as changes in heart rate, blood pressure, or patient movement—patients may still experience intraoperative awareness ( 3 ). The depth and effect of anesthesia in patients are essentially the result of an interaction between two factors: the pharmacological effects of the anesthetic drug and the patient’s clinical signs. The drug effect includes hypnotic components that induce unconsciousness ( 4 ). In fact, the primary effect of the drug is to cause drowsiness and loss of consciousness, while its secondary effects include analgesia and the modulation of various reflexes in the patient’s body ( 5 ). Determining the appropriate dosage of anesthetic drugs according to the patient’s required level of anesthesia is the responsibility of the attending anesthesiologist ( 6 ). The prescribed anesthetic drugs are determined based on the surgeon’s requirements for the depth and duration of anesthesia ( 7 ). Proper pain control during induction, maintenance of anesthesia, throughout surgery, at the end of the procedure, during extubation, and in the recovery period leads to minimal changes in the patient’s hemodynamic status ( 8 ). Consequently, this helps prevent cardiovascular complications, atelectasis, increased intracranial and intraocular pressure, and ileus ( 9 ). Postoperative pain can lead to various complications affecting multiple organ systems ( 10 ). The most significant of these include atelectasis, hypoxia and hypercapnia due to inadequate ventilation, increased blood pressure and heart rate, myocardial ischemia, cardiac arrhythmias, hyperglycemia, water and salt retention, suppression of the immune system, increased platelet aggregation and coagulation, ileus, and urinary retention ( 11 ). Therefore, the intensity of postoperative pain and its proper management play a crucial role in preventing and treating these complications ( 12 ). Dexmedetomidine (Dexdor) is a highly selective α2-adrenergic receptor agonist. It has sedative, analgesic, and opioid-sparing effects, making it suitable for both short-term and long-term sedation ( 13 ). Its sympatholytic properties make it an attractive option for use as an intraoperative antihypertensive agent, resulting in reduced heart rate and cardiac output. The drug acts by activating receptors in the brain and spinal cord, leading to bradycardia, hypotension, drowsiness, and analgesia ( 14 ). Dexmedetomidine is a substrate of CYP2A6. The majority of the drug (95%) is excreted unchanged in the urine, while 5% is eliminated via feces. Its elimination half-life in the body is approximately one to two hours ( 15 ). Remifentanil, marketed under the brand name Ultiva, is a potent, short-acting synthetic opioid analgesic ( 16 ). It is administered to patients during surgery for pain relief and as an adjunct to anesthesia. Due to its minimal neurotoxic effects and its ability to maintain stable hemodynamics, remifentanil is widely used in clinical practice ( 17 ). It is a short-acting opioid with a rapid onset of action and is used alongside other anesthetic agents. Studies have shown that when remifentanil is used as an adjuvant in anesthesia, it effectively reduces blood pressure and heart rate ( 18 ). Therefore, both dexmedetomidine and remifentanil are effective in controlling hemodynamic responses during surgery ( 19 ). Propofol is a hypnotic and sedative agent that rapidly and reliably induces loss of consciousness. It is also associated with smooth and quick recovery, which distinguishes it from many other anesthetic regimens ( 20 , 21 ). Given these considerations, there is a need to identify an optimal drug combination for induction and maintenance of anesthesia to ensure that patients do not experience the unpleasant sensations of awakening or pain during surgery. In addition, such a combination should minimize adverse effects, serious complications, recovery time, and the incidence of postoperative nausea and vomiting. Therefore, in this study, we aim to evaluate the effects and outcomes of pain control and the incidence of postoperative nausea and vomiting in lumbar spine surgery, comparing treatment with dexmedetomidine to intravenous remifentanil. Methods Study Design The present study was designed as a clinical trial to evaluate patients’ responses to dexmedetomidine and remifentanil during lumbar spine surgery. Clinical trials provide critical data on drug dosage, safety, and efficacy. This study was conducted following medical protocols after obtaining approval from health authorities, the ethics committee, and an IRCT registration code. The research was performed at Shahid Madani Treatment Center in 2024, including 92 volunteer patients randomly assigned into two groups for comparative analysis of the two anesthetic agents. The primary objective of the trial was to ensure the scientific validity and reproducibility of the results. Study Population The study population consisted of patients undergoing lumbar spine surgery involving 3 to 5 vertebrae at Shahid Madani Hospital, receiving anesthesia with either dexmedetomidine or remifentanil. A total of 92 patients were enrolled and randomly divided into two groups of 46 each, matched for age and gender to minimize confounding factors. Inclusion criteria included patients aged 18–65 years, who provided informed consent, with no history of drug abuse, substance misuse, or alcohol dependence. Patients had no history of neurological, neuromuscular, or psychiatric disorders (particularly seizures or epilepsy), no pulmonary or cardiovascular diseases, and no long-term or chronic use of analgesics, including cyclooxygenase-2 inhibitors. Exclusion criteria included patients with cardiac conduction blocks (atrioventricular, intraventricular, or sinoatrial), bradycardia (heart rate < 50 bpm), heart failure with ejection fraction < 40%, epilepsy or seizure disorders, obstructive sleep apnea syndrome, need for emergency surgery, unpredictable complications such as severe bleeding, pregnancy, or breastfeeding. Sample Size and Randomization The sample size was determined using one-way ANOVA, with an effect size of 0.25 based on Cohen’s recommendation, using G*Power software. With a power of 80% and a confidence level of 95%, 46 participants per group (total 92) were required. Block randomization was performed using Excel sequences (BA, BA), (AB, AB), (BA, AB), (AB, BA), (BB, AA), and (AA, BB), where A represented the intervention group and B the comparison group. One block was randomly selected, and participants were assigned according to the sequence of letters. This process continued until the target sample size was reached. Sampling and Data Collection Data were collected using simple random sampling, including checklists and patient medical records. The study included two components: Theoretical Section A literature review was conducted using digital databases, including ScienceDirect, Elsevier, Springer, PubMed, IranDoc, and others. Relevant articles were collected and synthesized. Experimental Section Statistical and clinical data were obtained from patients undergoing lumbar spine surgery under dexmedetomidine or remifentanil anesthesia. Research Implementation Eligible patients were randomly assigned to either the remifentanil or dexmedetomidine group using computer-generated single-block randomization. All patients were continuously monitored for vital signs (heart rate, blood pressure, respiratory rate, and oxygen saturation) during surgery and recovery. A 20-gauge angiocatheter was placed, and infusion of Ringer’s solution or normal saline was initiated. Premedication included midazolam (0.3 mg/kg) and fentanyl (1–2 µg/kg). Anesthesia induction was performed with propofol (1–2 mg/kg) and atracurium (0.5 mg/kg), followed by mask ventilation with oxygen for 3 minutes and endotracheal intubation for 1 minute. Maintenance anesthesia was performed using a continuous infusion of remifentanil (0.01 µg/kg/min) in the remifentanil group or dexmedetomidine (0.01 µg/kg/min) in the dexmedetomidine group. At the end of surgery, atropine (0.02 mg/kg) and neostigmine (0.04 mg/kg) were administered to reverse neuromuscular blockade, and patients were transferred to the recovery room after extubation. Outcome Assessment Pain was assessed using the Visual Analog Scale (VAS), Observation Pain Score (OPS), and Ramsay Sedation Assessment Scale at T1 (before discharge from recovery), T2 (2 hours postoperatively), and VAS at 24 hours. If T3 pain scores exceeded 3, morphine (2–5 mg every 4 hours IV) was administered under cardiac and glucose monitoring. Patients with morphine allergy or contraindications received pethidine (25–30 mg/kg IV). Pain onset times were recorded. Nausea and vomiting were evaluated at T1 (before discharge from recovery), T2 (2 hours postoperatively), T3 (8 hours postoperatively), and T4 (24 hours postoperatively). Ondansetron (8 mg IV) was administered as needed. Data Analysis Method Data analysis was performed using SPSS version 16. In this study, a p-value of less than 0.05 was considered statistically significant. Quantitative data were reported as frequency distribution, mean ± standard deviation, and median (interquartile range), depending on the type of variable, while qualitative data were reported as frequencies. In this study, remifentanil and dexmedetomidine were considered independent variables, and postoperative nausea and vomiting were considered dependent variables. These were analyzed using the Chi-square test and the t-test. Adhering to the Consolidated Standards of Reporting Trials (CONSORT) guidelines and the Helsinki Declaration (Fig. 1 ) ( 22 ). Results In the present study, a total of 92 patients scheduled for lumbar spine surgery participated and were randomly assigned into two groups of 46 patients each, receiving either dexmedetomidine or remifentanil. Five patients were ultimately excluded due to excessive intraoperative bleeding. Consequently, 44 patients remained in the remifentanil group and 43 in the dexmedetomidine group. The mean age of all patients was 51.13 ± 9.75 years (50.69 ± 8.9 years in the remifentanil group and 51.58 ± 10.6 years in the dexmedetomidine group). Women comprised 51.8% of the total participants and men 48.2% (remifentanil group: 53% women and 47% men; dexmedetomidine group: 51.2% women and 48.8% men). The mean weight of all patients was 77.4 ± 11.5 kg (79 ± 11.4 kg in the remifentanil group and 75.8 ± 11.8 kg in the dexmedetomidine group). The mean height of all patients was 168.4 ± 9.4 cm (169.8 ± 8.2 cm in the remifentanil group and 167.1 ± 10.8 cm in the dexmedetomidine group). In the remifentanil group, 40.8% of patients reported a history of hypertension, while in the dexmedetomidine group, 27.9% reported a history of hypertension and use of antihypertensive medication. Additionally, 32.5% of patients in the remifentanil group and 28.2% in the dexmedetomidine group reported a history of type 2 diabetes. The preoperative VAS score was 3.05 ± 1.8 in the remifentanil group and 2.6 ± 1.82 in the dexmedetomidine group. According to Table 1 , no statistically significant differences were observed in any of the preoperative variables; in other words, the P-values for comparing these variables were all greater than 0.05. Table 1 Comparison of Preoperative Variables in Lumbar Spine Surgery Between the Remifentanil and Dexmedetomidine Groups. Variable Dexmedetomidine Remifentanil p-value Age 51.58 ± 10.6 50.69 ± 8.9 0.67 Gender (Male/Female) 48.8 (22/21) 47 (23/21) 0.56 Weight 75.08 ± 11.8 79 ± 11.4 0.22 Height 167.1 ± 10.8 169.±8.2 0.25 Blood Pressure 12 (27/9) 18 (40/8) 0.7 Diabetes 13 (28/2) 14 (32/5) 0.8 Pre-operative VAS Score 2.6 ± 1.82 3.05 ± 1.8 0.27 Assessment of Intraoperative and Immediate Postoperative Variables The mean duration of surgery was 282 ± 70 minutes in the remifentanil group and 219 ± 71.4 minutes in the dexmedetomidine group. The independent t-test showed no significant difference between the two groups in terms of age (P = 0.8). The mean duration of anesthesia was 323.2 ± 74.2 minutes in the remifentanil group and 257.1 ± 66.7 minutes in the dexmedetomidine group, with no significant difference in distribution between the groups (P = 0.63). Rescue analgesic use immediately postoperatively or in the recovery room was reported in 77% of patients in the remifentanil group and 64% in the dexmedetomidine group, with no significant difference between the groups (P = 0.15). The mean duration of stay in the recovery room was 74 ± 33 minutes in the remifentanil group and 95 ± 49 minutes in the dexmedetomidine group, with no statistically significant difference observed (P = 0.4). As shown in Table 2 , the chi-square test results indicated that some variables differed significantly between the groups. Postoperative nausea and vomiting (PONV) in the recovery room was experienced by 31.8% of patients in the remifentanil group and 11.6% of patients in the dexmedetomidine group, with a statistically significant difference (P = 0.028). Table 2 Comparison of Intraoperative and Recovery Room Variables Between the Two Groups (Fentanyl and Dexmedetomidine) Variable Dexmedetomidine Remifentanil P-value Surgical Time (min) 219 ± 71.4 282 ± 70 0.80 Anesthesia Time (min) 257.1 ± 66.7 233.2 ± 74.2 0.63 Nausea and Vomiting 5 (11.6) 14 (38/1) 0.028 Propofol Used (mg/kg/hr or similar unit) 1.69 ± 0.27 1.53 ± 0.2 0.4 Time to First Eye Opening (min) 18.6 ± 6.9 8.1 ± 5 0.001 Time to First Speaking (min) 20.9 ± 6.8 11.4 ± 5.3 0.001 Use of Rescue Analgesics (Frequency) 26 (64) 34 (77) 0.15 Time to First Rescue Analgesic (min) 23.8 ± 11.8 11.5 ± 9.8 0.001 Time Spent in Recovery Room (min) 95 ± 49 74 ± 33 0.4 The mean time to first eye opening was 18.6 ± 6.9 minutes in the dexmedetomidine group and 8.1 ± 5 minutes in the remifentanil group. The mean time to first postoperative verbal response was 20.9 ± 6.8 minutes in the dexmedetomidine group and 11.4 ± 5.3 minutes in the remifentanil group. Both variables showed statistically significant differences (P < 0.05). Additionally, the mean time to first use of analgesic medication was 23.8 ± 11.8 minutes in the dexmedetomidine group and 11.5 ± 9.8 minutes in the remifentanil group, which was also statistically significant (P < 0.05). Assessment of Postoperative Pain Scores Postoperative VAS scores showed significant differences between the groups. Immediately after surgery and in the recovery room, the mean VAS score was 4.1 ± 1.7 in the remifentanil group and 2.1 ± 1.3 in the dexmedetomidine group, indicating a statistically significant difference (P < 0.05). Two hours postoperatively, the mean VAS scores were 5.6 ± 1.5 in the remifentanil group and 3.5 ± 1.2 in the dexmedetomidine group, showing a significant difference as well (P < 0.05). At eight hours after surgery, the remifentanil group had a mean VAS score of 5 ± 1, while the dexmedetomidine group had 8.2 ± 0.9, again demonstrating a statistically significant difference. At 24 hours postoperatively, the mean VAS score was 4.6 ± 1.1 in the remifentanil group and 2.9 ± 1.1 in the dexmedetomidine group, with the difference being statistically significant. Figure 2 illustrates the comparison of postoperative VAS scores following lumbar spine surgery between the remifentanil and dexmedetomidine groups at different time points. As shown, the mean VAS scores for patients receiving remifentanil were consistently higher at all measured time points compared to those receiving dexmedetomidine. Additionally, according to the figure, when comparing VAS scores across different time points within each group, both the remifentanil and dexmedetomidine groups showed an initial increase in VAS scores from immediately after surgery up to two hours postoperatively, followed by a gradual decrease. Therefore, VAS scores reached their highest levels in both groups two hours after lumbar spine surgery. Postoperative Ramsay Sedation Assessment Scale (RSAS) Scores Postoperatively, the mean RSAS score was 2.1 ± 1 in the remifentanil group and 3.4 ± 0.4 in the dexmedetomidine group, indicating a statistically significant difference between the two groups (P < 0.05). At two hours postoperatively, the remifentanil group had a mean RSAS score of 2.8 ± 0.75, while the dexmedetomidine group had 1.7 ± 0.6, showing a statistically significant difference. Eight hours after surgery, the mean RSAS score was 2.5 ± 0.5 in the remifentanil group and 1.4 ± 0.49 in the dexmedetomidine group. Finally, at 24 hours postoperatively, the RSAS scores were 2.3 ± 0.5 for the remifentanil group and 1.5 ± 0.6 for the dexmedetomidine group. According to the data presented in Fig. 3 , RSAS scores showed statistically significant differences between the two groups at all measured time points (P < 0.05). Figure 3 shows the comparison of postoperative RSAS scores following lumbar spine surgery between the remifentanil and dexmedetomidine groups at different time points. As observed, the mean RSAS scores for patients receiving remifentanil were consistently higher at all measured time points compared to those receiving dexmedetomidine. Additionally, when comparing RSAS scores across different time points within each group, both the remifentanil and dexmedetomidine groups showed an initial increase in RSAS scores from immediately after surgery up to two hours postoperatively, followed by a gradual decrease, although some fluctuations were observed in the dexmedetomidine group. Therefore, RSAS scores reached their highest levels in both groups two hours after lumbar spine surgery. Observation Pain Score (OPS) Assessment Postoperatively, the mean OPS in the remifentanil group was − 0.77, while in the dexmedetomidine group it was − 0.33, indicating a statistically significant difference between the two anesthetic groups, similar to the previously reported parameters. At two hours postoperatively, the mean OPS was − 1.2 in the remifentanil group and − 0.58 in the dexmedetomidine group. Eight hours after surgery, the mean OPS was − 1.04 for the remifentanil group and − 0.41 for the dexmedetomidine group. Finally, at 24 hours postoperatively, the OPS scores were − 0.93 in the remifentanil group and − 0.41 in the dexmedetomidine group (Fig. 4 ). Comparison of Postoperative Pain Scores Figure4illustrates the comparison of postoperative pain scores in patients receiving remifentanil and dexmedetomidine during lumbar spine surgery at different time points. As observed, the mean pain scores for patients administered remifentanil were consistently higher than those for patients receiving dexmedetomidine at all measured time points. Additionally, when comparing pain scores within each group over time, it is evident that in both the remifentanil and dexmedetomidine groups, pain scores initially increased up to two hours postoperatively and then gradually decreased. In the dexmedetomidine group, the pain scores remained relatively stable. Therefore, the highest pain scores in both groups occurred two hours after lumbar spine surgery. Postoperative Nausea and Vomiting (PONV) after Lumbar Spine Surgery The relationship between PONV at various postoperative time points and the type of anesthetic drug was analyzed using the chi-square test. The results indicated that there was no statistically significant difference in postoperative nausea between the two groups at the specified time intervals. As shown in Fig. 4 , in the study population of 87 patients, approximately 10% (fewer than 10 patients) experienced nausea after surgery. Although the highest incidence of nausea in both drug groups was observed 2 hours postoperatively (8 patients in the remifentanil group and 9 patients in the dexmedetomidine group), the number of patients experiencing nausea decreased over time. By 24 hours after surgery, only 3 patients in the remifentanil group and 2 patients in the dexmedetomidine group reported nausea (Table 3 ). Table 3 Relationship between PONV and the need for its treatment according to the type of anesthetic drug used Parameter Dexmedetomidine Remifentanil Time after surgery P-value Nausea 15 (16.3%) 17 (18.4%) 2 hours after surgery 0.82 18 (19.5%) 18 (19.5%) 8 hours after surgery 1.00 5 (5.4%) 6 (6.5%) 24 hours after surgery 0.88 Vomiting 11 (11.4%) 12 (13%) 2 hours after surgery 0.57 9 (9.8%) 10 (10.8%) 8 hours after surgery 0.04 6 (6.5%) 6 (6.5%) 24 hours after surgery 0.75 Need for antiemetic drug 10 (10.8%) 9 (9.7%) 2 hours after surgery 0.56 10 (10.8%) 6 (6.5%) 8 hours after surgery 0.24 5 (5.4%) 7 (7.6%) 24 hours after surgery 0.65 Postoperative Vomiting after Lumbar Spine Surgery The analysis of the number of patients who experienced postoperative vomiting showed no statistically significant difference between the two groups at any of the three specified time points. Considering the study population of 87 patients, approximately 38% experienced vomiting. At 2 hours postoperatively, 15 patients in each group experienced vomiting, which increased to 18 patients in each group at 8 hours postoperatively. By 24 hours after surgery, 6 patients in the remifentanil group and 5 patients in the dexmedetomidine group experienced vomiting (Table 3 ). Use of Antiemetic Medication during Postoperative Recovery Considering that antiemetic drugs were administered to prevent nausea and their effects were evaluated in both anesthesia groups, no statistically significant difference was observed between the two groups regarding the number of patients requiring antiemetic medication at the three specified time points. Figure 3 illustrates the number of patients for whom antiemetic medication influenced their recovery. As shown in the figure, 2 hours after surgery, the number of patients in both groups was approximately the same (9 patients in the remifentanil group and 10 patients in the dexmedetomidine group). However, at 8 hours postoperatively, the number of patients receiving antiemetics increased to 5 in the remifentanil group and 10 in the dexmedetomidine group. At 24 hours after lumbar spine surgery, the number of patients receiving antiemetics was 7 in the remifentanil group and 5 in the dexmedetomidine group. Assessment of the Need for Rescue Analgesics The evaluation of rescue analgesic administration within 24 hours after surgery yielded the following results. 26(59%) patients in the remifentanil group required analgesic medication during the 24h postoperative period, whereas 15(34%) patients in the dexmedetomidine group required it. Based on the reported p-value, a statistically significant difference was observed between the two groups (p = 0.045). Discussion Effective management of issues arising in the immediate postoperative period saves time and money ( 22 ). The likelihood of a specific complication occurring in a patient is determined by the nature of the surgical procedure, anesthetic techniques, and preoperative coordination ( 23 ). The risk of certain complications can be reduced through preoperative assessments and optimization( 24 ). One of the most common postoperative problems is patient pain, which a vast number of patients experience ( 25 ). Postoperative nausea and vomiting is another common complication, reported in 10 to 30 percent of patients ( 26 , 27 ). The present study aimed to compare the effects of remifentanil and dexmedetomidine on postoperative pain control following lumbar spine surgery. In this study, a total of 92 patients were enrolled and equally divided into two groups. Five patients were excluded from the study due to complications during surgery, resulting in a final allocation of 44 patients in the remifentanil group and 43 patients in the dexmedetomidine group. In a study conducted by Sgeape and colleagues, which was a systematic review and meta-analysis, intraoperative remifentanil was associated with an increased need for postoperative analgesics and opioid consumption. Additionally, the mean postoperative pain scores were lower in the dexmedetomidine group compared to the remifentanil group, which is consistent with the results of our study ( 28 , 19 ). In a study conducted by Louise Jensen Lundorf and colleagues, dexmedetomidine was identified as a promising approach for improving postoperative complications and providing analgesic effects ( 3 ). Consistent with our study results, pain control outcomes with dexmedetomidine showed lower scores compared to remifentanil ( 29 ). In a study conducted by Helen Blouin and colleagues, the results showed that the analgesic effects were similar in both groups. The administration of dexmedetomidine was similar to our study, but a higher dose of remifentanil was used. Additionally, the type of surgery in that study involved non-cardiac major to moderate surgeries ( 30 ). The differences in results may be attributed to the variation in drug dosages and the type of surgical procedures performed. In a study conducted by Gillian M. Keating and colleagues, dexmedetomidine was associated with fewer postoperative complications compared to midazolam and propofol ( 21 ). In this study, patients receiving dexmedetomidine were able to awaken more easily and communicate better than those who received midazolam or propofol ( 31 ). In a study conducted by Becham and colleagues, no significant difference was reported between dexmedetomidine and placebo in reducing postoperative nausea and vomiting following laparoscopic bypass surgery ( 32 ). Dexmedetomidine was used as an adjuvant along with propofol and fentanyl and compared with placebo ( 33 ). In our study, however, dexmedetomidine was compared with remifentanil. Nevertheless, the results of that study were consistent with our findings. In a study conducted by Wonjung Hwang and colleagues, the type of surgery and the drugs used were the same as in our study ( 22 ). The results showed that the mean pain scores (VAS) were lower in the dexmedetomidine group compared to the remifentanil group. Additionally, there was no statistically significant difference in nausea and vomiting between the remifentanil and dexmedetomidine groups ( 34 ). The need for analgesics was higher in the remifentanil group than in the dexmedetomidine group ( 35 ). The findings of that study were completely consistent with the results of our study. In a study by Sung and colleagues, postoperative complications following lumbar vertebral fusion surgery, including nausea, vomiting, and pain, were significantly reduced in the dexmedetomidine group compared to the remifentanil and placebo groups ( 36 – 38 ). In this study, the drug was administered as a bolus at the end of surgery and continued postoperatively via patient-controlled analgesia (PCA) infusion ( 39 ). The difference in results may be attributed to the timing of dexmedetomidine administration at the end of surgery and its continued postoperative infusion through the PCA pump. The results of the study showed that dexmedetomidine used during anesthesia for lumbar spine surgery did not have a significant effect on postoperative nausea and vomiting compared to remifentanil. However, there was a significant difference in postoperative pain scores between the two groups, with the mean pain scores being lower in the dexmedetomidine group than in the remifentanil group. Conclusion Dexmedetomidine, as a propofol-based adjuvant, demonstrated greater efficacy in reducing and managing postoperative pain for up to 24 hours following lumbar spine surgery compared to remifentanil. The effects of the two drugs on postoperative nausea and vomiting (PONV) were similar, although dexmedetomidine showed a slightly better overall outcome. Therefore, dexmedetomidine may be used as a propofol-based maintenance anesthetic instead of remifentanil for more effective management of pain and PONV. It should also be noted that gastrointestinal and spine surgeries are inherently high-risk procedures for postoperative nausea and vomiting, which may explain why dexmedetomidine has been found effective in reducing PONV in other surgeries, such as thyroidectomy and gynecological procedures. Considering the high likelihood of postoperative pain, particularly after surgeries such as lumbar spine procedures, it is recommended to avoid any factors that may increase risk during anesthesia. For example, opioid-free anesthesia techniques may be employed. Given that dexmedetomidine possesses sedative, anxiolytic, analgesic, hypnotic, and sympatholytic effects, its use during anesthesia is still recommended, even though the results of this study were not statistically significant. Abbreviations Dexdor: Dexmedetomidine PONV: postoperative nausea and vomiting PCA: patient-controlled analgesia OPS: Observation Pain Score RSAS: Ramsay Sedation Assessment Scale VAS: Visual Analog Scale Declarations Ethics approval and consent to participate: This study was approved by the institutional ethics board of Alborz University of Medical Sciences (IR.ABZUMS.REC.1403.197). All procedures involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and its amendments and registered in the Iranian Registry of Clinical Trials(IRCT20241030063548N1 ) , Informed consent was obtained from each participant. CONSENT FOR PUBLICATION Not Applicable Consent to participate from the under 16 years old was given by a parent or legal guardian. Availability of data and materials All data generated or analysed during this study are included in this published article Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study. Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. Authors' contributions Dr. Maryam Mardani Hosseinabadi and Dr. Farshad Hassanzadeh Kiabi: conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Mahnaz Narimani Zamanabadi: Designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. Dr. Mehdi Alihosseini: Coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Acknowledgment: We would like to express our sincere gratitude to the Shahid Kamali Research Center and Alborz University of Medical Sciences, Karaj, Iran, for their invaluable support and collaboration in the successful completion of this research project. References Farahani PK, Nejat SK. Preoperative C-reactive protein as a predictor of conversion and complications in laparoscopic cholecystectomy for acute cholecystitis. BMC surgery. 2025 Oct 14;25(1):476. Farahani PK. Laparoscopic wedge resection and omental patch in an elderly patient with acute abdomen: a case report. Journal of Medical Case Reports. 2025 Aug 1;19(1):381. Jessen Lundorf L, Korvenius Nedergaard H, Moller AM. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Database Syst Rev. 2016;2:Cd010358 . Farahani PK, Karimi A, Yazdani D, Kiabi FH, Abbasi Z. Comparison of the Effect of Preemptive Pregabalin versus Pethidine on Postoperative Pain after Septorhinoplasty. JPRAS Open. 2025 Sep 26. Qiu J, Luo Z. The comparison of dexmedetomidine and ketamine for pediatric dental surgery: A metaanalysis of randomized controlled studies. Medicine (Baltimore). 2019;98(17):e15068. Politis C, Lambrichts I, Agbaje JO. Neuropathic pain after orthognathic surgery. Oral surgery, oral medicine, oral pathology and oral radiology.2014;117(2):ie102-e7. Linn J, Trantor I, Teo N, Thanigaivel R, Goss A. The differential diagnosis of toothache from other orofacial pains in clinical practice. Australian Dental Journal. Nikolai Bogduk, Radiological Anatomy of the Lumbar Spine. Fifth Edition ed. Vol. 5. 2012: Elsevier. Farahani PK, Safaei N. Comparison of two methods: clipping and suturing in laparoscopic appendectomy. Surgery Open Science. 2024 Jun 1;19:162-5. Farahani PK. Laparoscopic wedge resection and omental patch in an elderly patient with acute abdomen: a case report. Journal of Medical Case Reports. 2025 Aug 1;19(1):381. Mohsen Sheykhhasan, M.N., Mahdieh Ghiasi, Stem cell therapy for intervertebral disc regeneration: review article. Tehran Univ Med J, 2014.74(11). Demir, E., et al., Finite element modelling of hybrid stabilization systems for the human lumbar spine. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, 2020. 234(12): p.14091420. Jelodar AG, Makrani NF, Shafizad M, Saeidiborojeni H, Kiabi FH, Ebrahimian M. Comparison of dexmedetomidine and ketamine in adjuvant with morphine for postoperative pain management following lumbar fusion surgery. Interdisciplinary Neurosurgery. 2023 Sep 1;33:101767. Aezi G, Shafizad M, Firouzian A, Mirani A, Kiabi FH. Effects of tizanidine and clonidine on postoperative pain after lumbar fusion surgery. Interdisciplinary Neurosurgery. 2023 Mar 1;31:101680. Beiranvand S, Hasanzadeh-Kiabi F. Application of bone morphogenetic protein in spinal fusion surgery. IntechOpen; 2021 Apr 28. Karimi A, Amini M, Hashemiyazdi SH, Etemadian M, Kiabi FH, Baghdashti MB. The effect of ketamine and oxytocin with pethidine in postoperative pain control in patients with laparoscopic cholecystectomy. International Journal of Surgery Open. 2025:10-97. Christina, Naimisha B, Christina B, Mick P-C, G. R, Mesenchymal stem cells transplanted with self- assembling scaffolds differentiated to regenerate nucleus pulposus in an ex vivo model of degenerative disc disease. Applied Materials Today, 2020. 18. Beiranvand S, Kiabi FH. Nanoencapsulation of Colchicum speciosum for Alleviating Lower Back Pain. Current Nanomedicine. 2025 Apr;15(2):173-9. Grape S, Kirkham KR, Frauenknecht J, Albrecht E. Intra-operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta-analysis with trial sequential analysis. Anaesthesia. 2019 Jun;74(6):793-800. doi:10.1111/anae.14657. Jessen Lundorf L, Korvenius Nedergaard H, Møller AM. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Database Syst Rev. 2016 Feb 18;2(2):CD010358. Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. Hwang W, Lee J, Park J, Joo J: Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: A randomized controlled study. BMC Anesthesiol 2015; 15:21. Sneyd JR, Rigby-Jones AE. Remimazolam for anaesthesia or sedation. Curr Opin Anaesthesiol. 2020 Aug;33(4):506-511. Faranak R,Soudabeh D,Mohamadreza G,Alireza P,Mojtaba M.D,Arash T. Bi,Zeinab A., Controlled hypotension during rhinoplasty: A comparison of dexmedetomidine with magnesium sulfate. Anesthesiology and pain medicine, 2017. 7(6) Gupta, P, Choudhary R, Ojha T, Jethava D., Dexmedetomidine as an adjuvant for hypotensive anaesthesia during functional endoscopic sinus surgery (FESS). IOSR J Dent Med Sci, 2016. 15(8): p.143-6 Zamani, F., Naseri N, Farmani F, Kamali A., Comparison of the Effect of Dexmedetomidine and Remifentanil on Controlled Hypotension During Rhinoplasty: A Clinical Trial Study. Int Tinnitus J,2021. 24(2): p. 60-64 Elbakry AE, Ibrahim E. Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery. Minerva anestesiologica. 2017 Dec;83(12):1248-54. Hwang W, Lee J, Park J, Joo J: Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: A randomized controlled study. BMC Anesthesiol 2015; 15:21. Lee, H.S., Yoon H.Y, Hwang .S.H., Can dexmedetomidine influence recovery profiles from general anesthesia in nasal surgery? Otolaryngology–Head and Neck Surgery,2018. 158(1): p.43-53. Beloeil H. Opioid-free anesthesia. Best Practice & Research Clinical Anaesthesiology. 2019 Sep 1;33(3):353-60. Abdelraheem, T.M. and A.M. Elkeblawy, Remifentanil versus labetalol for deliberate hypotensive anesthesia in children undergoing cochlear implantation: A randomized clinical trial. Egyptian Journal of Anaesthesia, 2021. 37(1): p.281286 Taher - Baneh N, Ghadamie N, Sarshivi F, Sahraie R. Comparison of fentanyl and dexmedetomidine as an adjuvant to bupivacaine for unilateral spinal anesthesia in lower limb surgery: a randomized trial. Anestesiol. 2019;69(4) Rahimzadeh P, Faiz H, Imani F, Derakhshan P. Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs. BMC Anesthesiology. 2018;18(62). Patel V, Patel H. A comparison between dexmedetomidine and midazolam infusion on characteristic of spinal anesthesia. Int Med Sci Public Health.2016;5(5):906 – 10. Reichle FM, Conzen PF. Halogenated inhalational anaesthetics. Best Pract Res ClinAnaesthesiol 2003; 17(1): 29-46. Devasya A, Sarpangala M. Dexmedetomidine: A Review of a Newer Sedative in Dentistry. J Clin Pediatr Dent. 2015;39(5):401-9. Song Y, Shim JK, Song JW, Kim EK, Kwak YL. Dexmedetomidine added to an opioid-based analgesic regimen for the prevention of postoperative nausea and vomiting in highly susceptible patients: a randomised controlled trial. European Journal of Anaesthesiology (EJA). 2016 Feb 1;33(2):75-83. Anderson J, Grevstad U, Siegel H, Dahl J, Aex M, Mathiesen O,. Doe s Dexmedetomidine Have a Perineural Mechanism of Action When Used as an Adjuvant to Ropivacaine: A Paired, Blinded, Randomized Trial in Healthy Volunteer. Anesthesiology. 2017; 126:66-73. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8007817","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556488249,"identity":"31cb4824-8869-41d6-a073-5ca17ec01aae","order_by":0,"name":"Maryam Mardani Hosseinabadi","email":"","orcid":"","institution":"alborz university of medical sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"Mardani","lastName":"Hosseinabadi","suffix":""},{"id":556488250,"identity":"3b1424eb-58c1-4ed0-b6da-1ee1104078e3","order_by":1,"name":"Mahnaz Narimani Zamanabadi","email":"","orcid":"","institution":"Tehran Medical 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1","display":"","copyAsset":false,"role":"figure","size":167637,"visible":true,"origin":"","legend":"\u003cp\u003eConsort flow diagram\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8007817/v1/31d56e9440cf3ea981d5b4d2.png"},{"id":97720075,"identity":"04c38882-426c-41cc-8d28-e5fad31854be","added_by":"auto","created_at":"2025-12-08 15:34:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61942,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of postoperative VAS scores between the Remifentanil and Dexmedetomidine groups at different time points.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-8007817/v1/781ff2661ec0d81f5fbc57f8.png"},{"id":97720076,"identity":"9c88a979-ac25-4790-8d8a-e8a8b95e14ef","added_by":"auto","created_at":"2025-12-08 15:34:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":54266,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Ramsay Sedation Assessment Scale after surgery between the remifentanil and dexmedetomidine groups at different times.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8007817/v1/33a63798accd1a2cf7be2265.png"},{"id":97895854,"identity":"b710c398-359d-4bbf-acdc-9648c0f192ae","added_by":"auto","created_at":"2025-12-10 15:35:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":61489,"visible":true,"origin":"","legend":"\u003cp\u003eInvestigation of the observation pain score after surgery between the remifentanil and dexmedetomidine groups.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-8007817/v1/90e7e7f5af6405795e160552.png"},{"id":100577673,"identity":"bcf86201-0f76-42eb-8592-2af2c325f1c0","added_by":"auto","created_at":"2026-01-19 10:40:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1212298,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8007817/v1/1ea35a40-e343-4cd0-86e1-2be48d25513b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparing the effects of Dexmedetomidine compared to intravenous remifentanil in controlling pain after lumbar spine surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the past, the effects of anesthetic drugs on the depth of anesthesia could be assessed by observing vital signs such as heart rate, blood pressure, breathing pattern, and the presence or absence of motor activity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although these measures are useful, the cardiopulmonary effects of anesthetics are generally considered side effects (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, in the absence of clinical signs of anesthesia\u0026mdash;such as changes in heart rate, blood pressure, or patient movement\u0026mdash;patients may still experience intraoperative awareness (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe depth and effect of anesthesia in patients are essentially the result of an interaction between two factors: the pharmacological effects of the anesthetic drug and the patient\u0026rsquo;s clinical signs. The drug effect includes hypnotic components that induce unconsciousness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In fact, the primary effect of the drug is to cause drowsiness and loss of consciousness, while its secondary effects include analgesia and the modulation of various reflexes in the patient\u0026rsquo;s body (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Determining the appropriate dosage of anesthetic drugs according to the patient\u0026rsquo;s required level of anesthesia is the responsibility of the attending anesthesiologist (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe prescribed anesthetic drugs are determined based on the surgeon\u0026rsquo;s requirements for the depth and duration of anesthesia (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Proper pain control during induction, maintenance of anesthesia, throughout surgery, at the end of the procedure, during extubation, and in the recovery period leads to minimal changes in the patient\u0026rsquo;s hemodynamic status (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Consequently, this helps prevent cardiovascular complications, atelectasis, increased intracranial and intraocular pressure, and ileus (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePostoperative pain can lead to various complications affecting multiple organ systems (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The most significant of these include atelectasis, hypoxia and hypercapnia due to inadequate ventilation, increased blood pressure and heart rate, myocardial ischemia, cardiac arrhythmias, hyperglycemia, water and salt retention, suppression of the immune system, increased platelet aggregation and coagulation, ileus, and urinary retention (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Therefore, the intensity of postoperative pain and its proper management play a crucial role in preventing and treating these complications (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDexmedetomidine (Dexdor) is a highly selective α2-adrenergic receptor agonist. It has sedative, analgesic, and opioid-sparing effects, making it suitable for both short-term and long-term sedation (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Its sympatholytic properties make it an attractive option for use as an intraoperative antihypertensive agent, resulting in reduced heart rate and cardiac output. The drug acts by activating receptors in the brain and spinal cord, leading to bradycardia, hypotension, drowsiness, and analgesia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Dexmedetomidine is a substrate of CYP2A6. The majority of the drug (95%) is excreted unchanged in the urine, while 5% is eliminated via feces. Its elimination half-life in the body is approximately one to two hours (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRemifentanil, marketed under the brand name Ultiva, is a potent, short-acting synthetic opioid analgesic (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It is administered to patients during surgery for pain relief and as an adjunct to anesthesia. Due to its minimal neurotoxic effects and its ability to maintain stable hemodynamics, remifentanil is widely used in clinical practice (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). It is a short-acting opioid with a rapid onset of action and is used alongside other anesthetic agents. Studies have shown that when remifentanil is used as an adjuvant in anesthesia, it effectively reduces blood pressure and heart rate (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Therefore, both dexmedetomidine and remifentanil are effective in controlling hemodynamic responses during surgery (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePropofol is a hypnotic and sedative agent that rapidly and reliably induces loss of consciousness. It is also associated with smooth and quick recovery, which distinguishes it from many other anesthetic regimens (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven these considerations, there is a need to identify an optimal drug combination for induction and maintenance of anesthesia to ensure that patients do not experience the unpleasant sensations of awakening or pain during surgery. In addition, such a combination should minimize adverse effects, serious complications, recovery time, and the incidence of postoperative nausea and vomiting. Therefore, in this study, we aim to evaluate the effects and outcomes of pain control and the incidence of postoperative nausea and vomiting in lumbar spine surgery, comparing treatment with dexmedetomidine to intravenous remifentanil.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThe present study was designed as a clinical trial to evaluate patients\u0026rsquo; responses to dexmedetomidine and remifentanil during lumbar spine surgery. Clinical trials provide critical data on drug dosage, safety, and efficacy. This study was conducted following medical protocols after obtaining approval from health authorities, the ethics committee, and an IRCT registration code. The research was performed at Shahid Madani Treatment Center in 2024, including 92 volunteer patients randomly assigned into two groups for comparative analysis of the two anesthetic agents. The primary objective of the trial was to ensure the scientific validity and reproducibility of the results.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of patients undergoing lumbar spine surgery involving 3 to 5 vertebrae at Shahid Madani Hospital, receiving anesthesia with either dexmedetomidine or remifentanil. A total of 92 patients were enrolled and randomly divided into two groups of 46 each, matched for age and gender to minimize confounding factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e included patients aged 18\u0026ndash;65 years, who provided informed consent, with no history of drug abuse, substance misuse, or alcohol dependence. Patients had no history of neurological, neuromuscular, or psychiatric disorders (particularly seizures or epilepsy), no pulmonary or cardiovascular diseases, and no long-term or chronic use of analgesics, including cyclooxygenase-2 inhibitors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion criteria\u003c/b\u003e included patients with cardiac conduction blocks (atrioventricular, intraventricular, or sinoatrial), bradycardia (heart rate\u0026thinsp;\u0026lt;\u0026thinsp;50 bpm), heart failure with ejection fraction\u0026thinsp;\u0026lt;\u0026thinsp;40%, epilepsy or seizure disorders, obstructive sleep apnea syndrome, need for emergency surgery, unpredictable complications such as severe bleeding, pregnancy, or breastfeeding.\u003c/p\u003e\n\u003ch3\u003eSample Size and Randomization\u003c/h3\u003e\n\u003cp\u003eThe sample size was determined using one-way ANOVA, with an effect size of 0.25 based on Cohen\u0026rsquo;s recommendation, using G*Power software. With a power of 80% and a confidence level of 95%, 46 participants per group (total 92) were required. Block randomization was performed using Excel sequences (BA, BA), (AB, AB), (BA, AB), (AB, BA), (BB, AA), and (AA, BB), where A represented the intervention group and B the comparison group. One block was randomly selected, and participants were assigned according to the sequence of letters. This process continued until the target sample size was reached.\u003c/p\u003e\n\u003ch3\u003eSampling and Data Collection\u003c/h3\u003e\n\u003cp\u003eData were collected using simple random sampling, including checklists and patient medical records. The study included two components:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTheoretical Section\u003c/strong\u003e\u003cp\u003eA literature review was conducted using digital databases, including ScienceDirect, Elsevier, Springer, PubMed, IranDoc, and others. Relevant articles were collected and synthesized.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExperimental Section\u003c/strong\u003e\u003cp\u003eStatistical and clinical data were obtained from patients undergoing lumbar spine surgery under dexmedetomidine or remifentanil anesthesia.\u003c/p\u003e\u003c/p\u003e\n\u003ch3\u003eResearch Implementation\u003c/h3\u003e\n\u003cp\u003eEligible patients were randomly assigned to either the remifentanil or dexmedetomidine group using computer-generated single-block randomization. All patients were continuously monitored for vital signs (heart rate, blood pressure, respiratory rate, and oxygen saturation) during surgery and recovery. A 20-gauge angiocatheter was placed, and infusion of Ringer\u0026rsquo;s solution or normal saline was initiated.\u003c/p\u003e\u003cp\u003ePremedication included midazolam (0.3 mg/kg) and fentanyl (1\u0026ndash;2 \u0026micro;g/kg). Anesthesia induction was performed with propofol (1\u0026ndash;2 mg/kg) and atracurium (0.5 mg/kg), followed by mask ventilation with oxygen for 3 minutes and endotracheal intubation for 1 minute. Maintenance anesthesia was performed using a continuous infusion of remifentanil (0.01 \u0026micro;g/kg/min) in the remifentanil group or dexmedetomidine (0.01 \u0026micro;g/kg/min) in the dexmedetomidine group.\u003c/p\u003e\u003cp\u003eAt the end of surgery, atropine (0.02 mg/kg) and neostigmine (0.04 mg/kg) were administered to reverse neuromuscular blockade, and patients were transferred to the recovery room after extubation.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eOutcome Assessment\u003c/h2\u003e\u003cp\u003ePain was assessed using the Visual Analog Scale (VAS), Observation Pain Score (OPS), and Ramsay Sedation Assessment Scale at T1 (before discharge from recovery), T2 (2 hours postoperatively), and VAS at 24 hours. If T3 pain scores exceeded 3, morphine (2\u0026ndash;5 mg every 4 hours IV) was administered under cardiac and glucose monitoring. Patients with morphine allergy or contraindications received pethidine (25\u0026ndash;30 mg/kg IV). Pain onset times were recorded.\u003c/p\u003e\u003cp\u003eNausea and vomiting were evaluated at T1 (before discharge from recovery), T2 (2 hours postoperatively), T3 (8 hours postoperatively), and T4 (24 hours postoperatively). Ondansetron (8 mg IV) was administered as needed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Analysis Method\u003c/h3\u003e\n\u003cp\u003eData analysis was performed using SPSS version 16. In this study, a p-value of less than 0.05 was considered statistically significant. Quantitative data were reported as frequency distribution, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, and median (interquartile range), depending on the type of variable, while qualitative data were reported as frequencies. In this study, remifentanil and dexmedetomidine were considered independent variables, and postoperative nausea and vomiting were considered dependent variables. These were analyzed using the Chi-square test and the t-test.\u003c/p\u003e\u003cp\u003e Adhering to the Consolidated Standards of Reporting Trials (CONSORT) guidelines and the Helsinki Declaration (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the present study, a total of 92 patients scheduled for lumbar spine surgery participated and were randomly assigned into two groups of 46 patients each, receiving either dexmedetomidine or remifentanil. Five patients were ultimately excluded due to excessive intraoperative bleeding. Consequently, 44 patients remained in the remifentanil group and 43 in the dexmedetomidine group.\u003c/p\u003e\u003cp\u003eThe mean age of all patients was 51.13\u0026thinsp;\u0026plusmn;\u0026thinsp;9.75 years (50.69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 years in the remifentanil group and 51.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6 years in the dexmedetomidine group). Women comprised 51.8% of the total participants and men 48.2% (remifentanil group: 53% women and 47% men; dexmedetomidine group: 51.2% women and 48.8% men).\u003c/p\u003e\u003cp\u003eThe mean weight of all patients was 77.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5 kg (79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 kg in the remifentanil group and 75.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 kg in the dexmedetomidine group). The mean height of all patients was 168.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 cm (169.8\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2 cm in the remifentanil group and 167.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 cm in the dexmedetomidine group).\u003c/p\u003e\u003cp\u003eIn the remifentanil group, 40.8% of patients reported a history of hypertension, while in the dexmedetomidine group, 27.9% reported a history of hypertension and use of antihypertensive medication. Additionally, 32.5% of patients in the remifentanil group and 28.2% in the dexmedetomidine group reported a history of type 2 diabetes.\u003c/p\u003e\u003cp\u003eThe preoperative VAS score was 3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 in the remifentanil group and 2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 in the dexmedetomidine group. According to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, no statistically significant differences were observed in any of the preoperative variables; in other words, the P-values for comparing these variables were all greater than 0.05.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Preoperative Variables in Lumbar Spine Surgery Between the Remifentanil and Dexmedetomidine Groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDexmedetomidine\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRemifentanil\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.69\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (Male/Female)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.8 (22/21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (23/21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.08\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHeight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e167.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e169.\u0026plusmn;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood Pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (27/9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (40/8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (28/2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (32/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-operative VAS Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eAssessment of Intraoperative and Immediate Postoperative Variables\u003c/h2\u003e\u003cp\u003eThe mean duration of surgery was 282\u0026thinsp;\u0026plusmn;\u0026thinsp;70 minutes in the remifentanil group and 219\u0026thinsp;\u0026plusmn;\u0026thinsp;71.4 minutes in the dexmedetomidine group. The independent t-test showed no significant difference between the two groups in terms of age (P\u0026thinsp;=\u0026thinsp;0.8).\u003c/p\u003e\u003cp\u003eThe mean duration of anesthesia was 323.2\u0026thinsp;\u0026plusmn;\u0026thinsp;74.2 minutes in the remifentanil group and 257.1\u0026thinsp;\u0026plusmn;\u0026thinsp;66.7 minutes in the dexmedetomidine group, with no significant difference in distribution between the groups (P\u0026thinsp;=\u0026thinsp;0.63).\u003c/p\u003e\u003cp\u003eRescue analgesic use immediately postoperatively or in the recovery room was reported in 77% of patients in the remifentanil group and 64% in the dexmedetomidine group, with no significant difference between the groups (P\u0026thinsp;=\u0026thinsp;0.15).\u003c/p\u003e\u003cp\u003eThe mean duration of stay in the recovery room was 74\u0026thinsp;\u0026plusmn;\u0026thinsp;33 minutes in the remifentanil group and 95\u0026thinsp;\u0026plusmn;\u0026thinsp;49 minutes in the dexmedetomidine group, with no statistically significant difference observed (P\u0026thinsp;=\u0026thinsp;0.4).\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the chi-square test results indicated that some variables differed significantly between the groups. Postoperative nausea and vomiting (PONV) in the recovery room was experienced by 31.8% of patients in the remifentanil group and 11.6% of patients in the dexmedetomidine group, with a statistically significant difference (P\u0026thinsp;=\u0026thinsp;0.028).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Intraoperative and Recovery Room Variables Between the Two Groups (Fentanyl and Dexmedetomidine)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDexmedetomidine\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRemifentanil\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e219\u0026thinsp;\u0026plusmn;\u0026thinsp;71.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e282\u0026thinsp;\u0026plusmn;\u0026thinsp;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnesthesia Time (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e257.1\u0026thinsp;\u0026plusmn;\u0026thinsp;66.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e233.2\u0026thinsp;\u0026plusmn;\u0026thinsp;74.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNausea and Vomiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (38/1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePropofol Used (mg/kg/hr or similar unit)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to First Eye Opening (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to First Speaking (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUse of Rescue Analgesics (Frequency)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34 (77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime to First Rescue Analgesic (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime Spent in Recovery Room (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95\u0026thinsp;\u0026plusmn;\u0026thinsp;49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74\u0026thinsp;\u0026plusmn;\u0026thinsp;33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe mean time to first eye opening was 18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 minutes in the dexmedetomidine group and 8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5 minutes in the remifentanil group. The mean time to first postoperative verbal response was 20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 minutes in the dexmedetomidine group and 11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 minutes in the remifentanil group. Both variables showed statistically significant differences (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eAdditionally, the mean time to first use of analgesic medication was 23.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8 minutes in the dexmedetomidine group and 11.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8 minutes in the remifentanil group, which was also statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eAssessment of Postoperative Pain Scores\u003c/h2\u003e\u003cp\u003ePostoperative VAS scores showed significant differences between the groups. Immediately after surgery and in the recovery room, the mean VAS score was 4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 in the remifentanil group and 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 in the dexmedetomidine group, indicating a statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eTwo hours postoperatively, the mean VAS scores were 5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 in the remifentanil group and 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 in the dexmedetomidine group, showing a significant difference as well (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eAt eight hours after surgery, the remifentanil group had a mean VAS score of 5\u0026thinsp;\u0026plusmn;\u0026thinsp;1, while the dexmedetomidine group had 8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, again demonstrating a statistically significant difference.\u003c/p\u003e\u003cp\u003eAt 24 hours postoperatively, the mean VAS score was 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 in the remifentanil group and 2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 in the dexmedetomidine group, with the difference being statistically significant.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the comparison of postoperative VAS scores following lumbar spine surgery between the remifentanil and dexmedetomidine groups at different time points. As shown, the mean VAS scores for patients receiving remifentanil were consistently higher at all measured time points compared to those receiving dexmedetomidine.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAdditionally, according to the figure, when comparing VAS scores across different time points within each group, both the remifentanil and dexmedetomidine groups showed an initial increase in VAS scores from immediately after surgery up to two hours postoperatively, followed by a gradual decrease. Therefore, VAS scores reached their highest levels in both groups two hours after lumbar spine surgery.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePostoperative Ramsay Sedation Assessment Scale (RSAS) Scores\u003c/h2\u003e\u003cp\u003ePostoperatively, the mean RSAS score was 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1 in the remifentanil group and 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 in the dexmedetomidine group, indicating a statistically significant difference between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eAt two hours postoperatively, the remifentanil group had a mean RSAS score of 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75, while the dexmedetomidine group had 1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6, showing a statistically significant difference.\u003c/p\u003e\u003cp\u003eEight hours after surgery, the mean RSAS score was 2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 in the remifentanil group and 1.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49 in the dexmedetomidine group.\u003c/p\u003e\u003cp\u003eFinally, at 24 hours postoperatively, the RSAS scores were 2.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5 for the remifentanil group and 1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 for the dexmedetomidine group. According to the data presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, RSAS scores showed statistically significant differences between the two groups at all measured time points (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the comparison of postoperative RSAS scores following lumbar spine surgery between the remifentanil and dexmedetomidine groups at different time points. As observed, the mean RSAS scores for patients receiving remifentanil were consistently higher at all measured time points compared to those receiving dexmedetomidine.\u003c/p\u003e\u003cp\u003eAdditionally, when comparing RSAS scores across different time points within each group, both the remifentanil and dexmedetomidine groups showed an initial increase in RSAS scores from immediately after surgery up to two hours postoperatively, followed by a gradual decrease, although some fluctuations were observed in the dexmedetomidine group. Therefore, RSAS scores reached their highest levels in both groups two hours after lumbar spine surgery.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eObservation Pain Score (OPS) Assessment\u003c/h2\u003e\u003cp\u003ePostoperatively, the mean OPS in the remifentanil group was \u0026minus;\u0026thinsp;0.77, while in the dexmedetomidine group it was \u0026minus;\u0026thinsp;0.33, indicating a statistically significant difference between the two anesthetic groups, similar to the previously reported parameters.\u003c/p\u003e\u003cp\u003eAt two hours postoperatively, the mean OPS was \u0026minus;\u0026thinsp;1.2 in the remifentanil group and \u0026minus;\u0026thinsp;0.58 in the dexmedetomidine group. Eight hours after surgery, the mean OPS was \u0026minus;\u0026thinsp;1.04 for the remifentanil group and \u0026minus;\u0026thinsp;0.41 for the dexmedetomidine group. Finally, at 24 hours postoperatively, the OPS scores were \u0026minus;\u0026thinsp;0.93 in the remifentanil group and \u0026minus;\u0026thinsp;0.41 in the dexmedetomidine group (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eComparison of Postoperative Pain Scores\u003c/h2\u003e\u003cp\u003eFigure4illustrates the comparison of postoperative pain scores in patients receiving remifentanil and dexmedetomidine during lumbar spine surgery at different time points. As observed, the mean pain scores for patients administered remifentanil were consistently higher than those for patients receiving dexmedetomidine at all measured time points. Additionally, when comparing pain scores within each group over time, it is evident that in both the remifentanil and dexmedetomidine groups, pain scores initially increased up to two hours postoperatively and then gradually decreased. In the dexmedetomidine group, the pain scores remained relatively stable. Therefore, the highest pain scores in both groups occurred two hours after lumbar spine surgery.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003ePostoperative Nausea and Vomiting (PONV) after Lumbar Spine Surgery\u003c/h2\u003e\u003cp\u003eThe relationship between PONV at various postoperative time points and the type of anesthetic drug was analyzed using the chi-square test. The results indicated that there was no statistically significant difference in postoperative nausea between the two groups at the specified time intervals. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, in the study population of 87 patients, approximately 10% (fewer than 10 patients) experienced nausea after surgery. Although the highest incidence of nausea in both drug groups was observed 2 hours postoperatively (8 patients in the remifentanil group and 9 patients in the dexmedetomidine group), the number of patients experiencing nausea decreased over time. By 24 hours after surgery, only 3 patients in the remifentanil group and 2 patients in the dexmedetomidine group reported nausea (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship between PONV and the need for its treatment according to the type of anesthetic drug used\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDexmedetomidine\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRemifentanil\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTime after surgery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNausea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (16.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (18.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (19.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (19.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVomiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (11.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (13%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (9.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNeed for antiemetic drug\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (9.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (5.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (7.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 hours after surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003ePostoperative Vomiting after Lumbar Spine Surgery\u003c/h2\u003e\u003cp\u003eThe analysis of the number of patients who experienced postoperative vomiting showed no statistically significant difference between the two groups at any of the three specified time points. Considering the study population of 87 patients, approximately 38% experienced vomiting. At 2 hours postoperatively, 15 patients in each group experienced vomiting, which increased to 18 patients in each group at 8 hours postoperatively. By 24 hours after surgery, 6 patients in the remifentanil group and 5 patients in the dexmedetomidine group experienced vomiting (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eUse of Antiemetic Medication during Postoperative Recovery\u003c/h2\u003e\u003cp\u003eConsidering that antiemetic drugs were administered to prevent nausea and their effects were evaluated in both anesthesia groups, no statistically significant difference was observed between the two groups regarding the number of patients requiring antiemetic medication at the three specified time points. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e illustrates the number of patients for whom antiemetic medication influenced their recovery. As shown in the figure, 2 hours after surgery, the number of patients in both groups was approximately the same (9 patients in the remifentanil group and 10 patients in the dexmedetomidine group). However, at 8 hours postoperatively, the number of patients receiving antiemetics increased to 5 in the remifentanil group and 10 in the dexmedetomidine group. At 24 hours after lumbar spine surgery, the number of patients receiving antiemetics was 7 in the remifentanil group and 5 in the dexmedetomidine group.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eAssessment of the Need for Rescue Analgesics\u003c/h2\u003e\u003cp\u003eThe evaluation of rescue analgesic administration within 24 hours after surgery yielded the following results. 26(59%) patients in the remifentanil group required analgesic medication during the 24h postoperative period, whereas 15(34%) patients in the dexmedetomidine group required it. Based on the reported p-value, a statistically significant difference was observed between the two groups (p\u0026thinsp;=\u0026thinsp;0.045).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEffective management of issues arising in the immediate postoperative period saves time and money (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The likelihood of a specific complication occurring in a patient is determined by the nature of the surgical procedure, anesthetic techniques, and preoperative coordination (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The risk of certain complications can be reduced through preoperative assessments and optimization(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). One of the most common postoperative problems is patient pain, which a vast number of patients experience (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Postoperative nausea and vomiting is another common complication, reported in 10 to 30 percent of patients (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe present study aimed to compare the effects of remifentanil and dexmedetomidine on postoperative pain control following lumbar spine surgery. In this study, a total of 92 patients were enrolled and equally divided into two groups. Five patients were excluded from the study due to complications during surgery, resulting in a final allocation of 44 patients in the remifentanil group and 43 patients in the dexmedetomidine group.\u003c/p\u003e\u003cp\u003eIn a study conducted by Sgeape and colleagues, which was a systematic review and meta-analysis, intraoperative remifentanil was associated with an increased need for postoperative analgesics and opioid consumption. Additionally, the mean postoperative pain scores were lower in the dexmedetomidine group compared to the remifentanil group, which is consistent with the results of our study (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a study conducted by Louise Jensen Lundorf and colleagues, dexmedetomidine was identified as a promising approach for improving postoperative complications and providing analgesic effects (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Consistent with our study results, pain control outcomes with dexmedetomidine showed lower scores compared to remifentanil (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a study conducted by Helen Blouin and colleagues, the results showed that the analgesic effects were similar in both groups. The administration of dexmedetomidine was similar to our study, but a higher dose of remifentanil was used. Additionally, the type of surgery in that study involved non-cardiac major to moderate surgeries (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The differences in results may be attributed to the variation in drug dosages and the type of surgical procedures performed.\u003c/p\u003e\u003cp\u003eIn a study conducted by Gillian M. Keating and colleagues, dexmedetomidine was associated with fewer postoperative complications compared to midazolam and propofol (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In this study, patients receiving dexmedetomidine were able to awaken more easily and communicate better than those who received midazolam or propofol (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a study conducted by Becham and colleagues, no significant difference was reported between dexmedetomidine and placebo in reducing postoperative nausea and vomiting following laparoscopic bypass surgery (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Dexmedetomidine was used as an adjuvant along with propofol and fentanyl and compared with placebo (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In our study, however, dexmedetomidine was compared with remifentanil. Nevertheless, the results of that study were consistent with our findings.\u003c/p\u003e\u003cp\u003eIn a study conducted by Wonjung Hwang and colleagues, the type of surgery and the drugs used were the same as in our study (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The results showed that the mean pain scores (VAS) were lower in the dexmedetomidine group compared to the remifentanil group. Additionally, there was no statistically significant difference in nausea and vomiting between the remifentanil and dexmedetomidine groups (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The need for analgesics was higher in the remifentanil group than in the dexmedetomidine group (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). The findings of that study were completely consistent with the results of our study.\u003c/p\u003e\u003cp\u003eIn a study by Sung and colleagues, postoperative complications following lumbar vertebral fusion surgery, including nausea, vomiting, and pain, were significantly reduced in the dexmedetomidine group compared to the remifentanil and placebo groups (\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). In this study, the drug was administered as a bolus at the end of surgery and continued postoperatively via patient-controlled analgesia (PCA) infusion (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The difference in results may be attributed to the timing of dexmedetomidine administration at the end of surgery and its continued postoperative infusion through the PCA pump.\u003c/p\u003e\u003cp\u003eThe results of the study showed that dexmedetomidine used during anesthesia for lumbar spine surgery did not have a significant effect on postoperative nausea and vomiting compared to remifentanil. However, there was a significant difference in postoperative pain scores between the two groups, with the mean pain scores being lower in the dexmedetomidine group than in the remifentanil group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDexmedetomidine, as a propofol-based adjuvant, demonstrated greater efficacy in reducing and managing postoperative pain for up to 24 hours following lumbar spine surgery compared to remifentanil. The effects of the two drugs on postoperative nausea and vomiting (PONV) were similar, although dexmedetomidine showed a slightly better overall outcome. Therefore, dexmedetomidine may be used as a propofol-based maintenance anesthetic instead of remifentanil for more effective management of pain and PONV. It should also be noted that gastrointestinal and spine surgeries are inherently high-risk procedures for postoperative nausea and vomiting, which may explain why dexmedetomidine has been found effective in reducing PONV in other surgeries, such as thyroidectomy and gynecological procedures.\u003c/p\u003e\u003cp\u003eConsidering the high likelihood of postoperative pain, particularly after surgeries such as lumbar spine procedures, it is recommended to avoid any factors that may increase risk during anesthesia. For example, opioid-free anesthesia techniques may be employed. Given that dexmedetomidine possesses sedative, anxiolytic, analgesic, hypnotic, and sympatholytic effects, its use during anesthesia is still recommended, even though the results of this study were not statistically significant.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDexdor: Dexmedetomidine\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePONV: postoperative nausea and vomiting\u003c/p\u003e\n\u003cp\u003ePCA: patient-controlled analgesia\u003c/p\u003e\n\u003cp\u003eOPS: Observation Pain Score\u003c/p\u003e\n\u003cp\u003eRSAS: Ramsay Sedation Assessment Scale\u003c/p\u003e\n\u003cp\u003eVAS: Visual Analog Scale\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the institutional ethics board of Alborz University of Medical Sciences (IR.ABZUMS.REC.1403.197). All procedures involving human participants were conducted in accordance with the ethical standards of the Declaration of Helsinki and its amendments and registered in the Iranian Registry of Clinical Trials(IRCT20241030063548N1\u003cstrong\u003e)\u003c/strong\u003e, Informed consent was obtained from each participant.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;from the under 16 years old was given by a parent or legal guardian.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors deny any conflict of interest in any terms or by any means during the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Maryam Mardani Hosseinabadi and Dr. Farshad Hassanzadeh Kiabi: conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr.\u0026nbsp;Mahnaz Narimani Zamanabadi: Designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr.\u0026nbsp;Mehdi Alihosseini: Coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003eAll authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.\u003cbr\u003e\u003cstrong\u003eAcknowledgment:\u003c/strong\u003e We would like to express our sincere gratitude to the Shahid Kamali Research Center and Alborz University of Medical Sciences, Karaj, Iran, for their invaluable support and collaboration in the successful completion of this research project.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFarahani PK, Nejat SK. 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Current Nanomedicine. 2025 Apr;15(2):173-9.\u003c/li\u003e\n \u003cli\u003eGrape S, Kirkham KR, Frauenknecht J, Albrecht E. Intra-operative analgesia with remifentanil vs. dexmedetomidine: a systematic review and meta-analysis with trial sequential analysis. Anaesthesia. 2019 Jun;74(6):793-800. doi:10.1111/anae.14657.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJessen Lundorf L, Korvenius Nedergaard H, M\u0026oslash;ller AM. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults. Cochrane Database Syst Rev. 2016 Feb 18;2(2):CD010358.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKeating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSchulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.\u003c/li\u003e\n \u003cli\u003eHwang W, Lee J, Park J, Joo J: Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: A randomized controlled study. BMC Anesthesiol 2015; 15:21.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSneyd JR, Rigby-Jones AE. Remimazolam for anaesthesia or sedation. Curr Opin Anaesthesiol. 2020 Aug;33(4):506-511.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFaranak R,Soudabeh D,Mohamadreza G,Alireza P,Mojtaba M.D,Arash T. Bi,Zeinab A., Controlled hypotension during rhinoplasty: A comparison of dexmedetomidine with magnesium sulfate. Anesthesiology and pain medicine, 2017. 7(6)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGupta, P, Choudhary R, Ojha T, Jethava D., Dexmedetomidine as an adjuvant for hypotensive anaesthesia during functional endoscopic sinus surgery (FESS). IOSR J Dent Med Sci, 2016. 15(8): p.143-6\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eZamani, F., Naseri N, Farmani F, Kamali A., Comparison of the Effect of Dexmedetomidine and Remifentanil on Controlled Hypotension During Rhinoplasty: A Clinical Trial Study. Int Tinnitus J,2021. 24(2): p. 60-64\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eElbakry AE, Ibrahim E. Propofol-dexmedetomidine versus propofol-remifentanil conscious sedation for awake craniotomy during epilepsy surgery. Minerva anestesiologica. 2017 Dec;83(12):1248-54.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHwang W, Lee J, Park J, Joo J: Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: A randomized controlled study. BMC Anesthesiol 2015; 15:21.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLee, H.S., Yoon H.Y, Hwang .S.H., Can dexmedetomidine influence recovery profiles from general anesthesia in nasal surgery? Otolaryngology\u0026ndash;Head and Neck Surgery,2018. 158(1): p.43-53.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBeloeil H. Opioid-free anesthesia. Best Practice \u0026amp; Research Clinical Anaesthesiology. 2019 Sep 1;33(3):353-60.\u003c/li\u003e\n \u003cli\u003eAbdelraheem, T.M. and A.M. Elkeblawy, Remifentanil versus labetalol for deliberate hypotensive anesthesia in children undergoing cochlear implantation: A randomized clinical trial. Egyptian Journal of Anaesthesia, 2021. 37(1): p.281286\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eTaher - Baneh N, Ghadamie N, Sarshivi F, Sahraie R. Comparison of fentanyl and dexmedetomidine as an adjuvant to bupivacaine for unilateral spinal anesthesia in lower limb surgery: a randomized trial. Anestesiol. 2019;69(4)\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRahimzadeh P, Faiz H, Imani F, Derakhshan P. Comparative addition of dexmedetomidine and fentanyl to intrathecal bupivacaine in orthopedic procedure in lower limbs. BMC Anesthesiology. 2018;18(62).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatel V, Patel H. A comparison between dexmedetomidine and midazolam infusion on characteristic of spinal anesthesia. Int Med Sci Public Health.2016;5(5):906 \u0026ndash; 10.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eReichle FM, Conzen PF. Halogenated inhalational anaesthetics. Best Pract Res ClinAnaesthesiol 2003; 17(1): 29-46.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDevasya A, Sarpangala M. Dexmedetomidine: A Review of a Newer Sedative in Dentistry. J Clin Pediatr Dent. 2015;39(5):401-9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSong Y, Shim JK, Song JW, Kim EK, Kwak YL. Dexmedetomidine added to an opioid-based analgesic regimen for the prevention of postoperative nausea and vomiting in highly susceptible patients: a randomised controlled trial. European Journal of Anaesthesiology (EJA). 2016 Feb 1;33(2):75-83.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAnderson J, Grevstad U, Siegel H, Dahl J, Aex M, Mathiesen O,. Doe s Dexmedetomidine Have a Perineural Mechanism of Action When Used as an Adjuvant to Ropivacaine: A Paired, Blinded, Randomized Trial in Healthy Volunteer. Anesthesiology. 2017; 126:66-73.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"pain, anesthesia, remifentanil, dexmedetomidine","lastPublishedDoi":"10.21203/rs.3.rs-8007817/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8007817/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePostoperative pain is one of the common side effects and one of the important problems of modern anesthesia, which is also awkward for patients. Post-operative pain can cause many complications, so postoperative pain control should be a comprehensive approach. Anesthetic drugs, anesthesia method and type of surgery are effective in the amount of pain after the operation of the patient, and with some optimizations, the patient's pain can be reduced and controlled.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eIn this trial, 92 patients who were candidates for lumbar spine surgery were included in the study. Anesthesia was maintained in these patients with dexmedomidine or remifentanil, and patients' pain was measured and monitored at certain hours after the operation. Data comparison and analysis of two groups was done in SPSS16 software.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIn this study, data from 92 patients were analyzed in two groups: one receiving remifentanil and the other dexmedetomidine. According to the results, the highest mean pain scores were recorded two hours after surgery: the VAS score was 5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 in the remifentanil group and 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 in the dexmedetomidine group. The RSAS score two hours after surgery was 2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75 for the remifentanil group and 1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 for the dexmedetomidine group. The OPS score two hours after surgery was \u0026minus;\u0026thinsp;1.2 in the remifentanil group and \u0026minus;\u0026thinsp;0.58 in the dexmedetomidine group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn examining the level of pain control in patients whose anesthesia was maintained in the two groups of dexmedetomidine and remifentanil, a significant difference was observed and dexmedetomiden group had less pain than remifentanil group.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003e The Ethics Committee of Alborz University of Medical Sciences granted ethical approval for our study protocol on April 11, 2024 (2024-04-11). The study was officially registered with the Iranian Clinical Trial Registry (IRCT20241030063548N1) on November 14, 2024.\u003c/p\u003e","manuscriptTitle":"Comparing the effects of Dexmedetomidine compared to intravenous remifentanil in controlling pain after lumbar spine surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 15:33:55","doi":"10.21203/rs.3.rs-8007817/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40542079-58b8-4ce7-b6b0-a58f89f5a1b2","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T10:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 15:33:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8007817","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8007817","identity":"rs-8007817","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}