• Ankith Naduvanahalli Vivekanandaswamy, Prasad ShettyAjoyA0000-0001-5885-7152Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital Pvt. Ltd, #313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamilnadu, 641001, India. ajoyshetty@gmail.com., Mugesh KannaRishiRDepartment of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital Pvt. Ltd, #313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamilnadu, 641001, India., and Rajasekaran Shanmuganathan.
• Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital Pvt. Ltd, #313, Mettupalayam Road, Sai Baba Colony, Coimbatore, Tamilnadu, 641001, India.
• Eur Spine J. 2021 Mar 1; 30 (3): 698-705.

PurposeTo evaluate whether use of dexmedetomidine, a centrally acting α2 adrenergic agonist, reduces opioid consumption in PSF.MethodsAdolescent idiopathic scoliosis patients who underwent PSF were randomized into morphine (M) and dexmedetomidine (D) group. M group received a 10 μg/kg/h IV infusion of morphine for 24 h post-surgery, while the D group received a 0.4 μg/kg/h IV infusion of dexmedetomidine. Trained nursing staffs recorded hourly vital parameters (blood pressure, pulse rate, respiratory rate, and oxygen saturation). Pain, postoperative nausea/vomiting (PONV), and sedation were rated using: the numerical rating scale (NRS), the PONV scale, and sedation status scale (SS). Preemptive analgesia with gabapentin and postoperative analgesia with ketorolac and paracetamol were used in both the groups. Any complications in the study groups were recorded.ResultsNo significant difference was noted between the groups (M vs D) with respect to NRS (3.1 ± 0.8 vs 2.7 ± 0.5) (p = 0.07) and breakthrough analgesia requirements (0.78 vs 0.45) (p = 0.17). A significant difference was noted between the groups with respect to the secondary outcome measures of time to ambulation (56.6 ± 12.7 h vs 45.2 ± 7.7 h), time to oral analgesics (84.3 ± 20 h vs 64.0 ± 15.4 h), and time to liquid intake (8.3 ± 1.3 h vs 7.2 ± 1.2 h). The M group had a higher PONV score (0.46 ± 0.3 vs 0.16 ± 0.1) (p < 0.001) and mean time to bowel opening (112.7 ± 28.4 h vs 90.1 ± 20.5 h) (p < 0.001). Additionally, the enema or suppository requirements for bowel opening were significantly more (0.59 ± 0.6 vs 0.26 ± 0.4) (p = 0.01) in the M group.ConclusionDexmedetomidine provided analgesia comparable to morphine with lower PONV scores. It also reduced the opioid requirements in the PSF patients without additional complications and can therefore be incorporated in pain management protocols.

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