Mohamed, A.A., Fares, K.M., & Mohamed, S.A. (2012). Efficacy of intrathecally administered dexmedetomidine versus dexmedetomidine with fentanyl in patients undergoing major abdominal cancer surgery. Pain Physician, 15, 339–348.

To investigate the safety and efficacy of intrathecal dexmedetomidine with or without fentanyl

Patients were randomly assigned to one of three groups. The control group received 0.5% bupivacaine and saline intrathecally, the second group received bupivacaine and 5 mcg of dexmedetomidine, and the third group received bupivacaine, 5 mcg of dexmedetomidine, and 25 mcg of fentanyl intrathecally prior to anesthesia. All patients received 5 mg of oral diazepam the night before surgery. Pain was assessed immediately after surgery and at two, four, six, eight, 12, and 24 hours. Postoperatively, intravenous tramadol at 100 mg was given upon patient request or if pain scores were three or greater.

• N = 90  
• MEAN AGE = 44.31 years
• MALES: 30%, FEMALES: 70%
• KEY DISEASE CHARACTERISTICS: All patients were receiving major abdominal surgeries. Specific disease types were not reported.

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Egypt

• PHASE OF CARE: Active antitumor treatment

Double-blinded, randomized, three-arm trial

• Visual Analog Scale (VAS) for pain severity
• Observers Assessment of Alertness/Sedation (OAA/S) scale
• Time to first request for analgesia
• Total analgesic consumption

There were no differences between groups in sedation scores or hemodynamic measures. Patients in the control bupivacaine-only group had significantly higher pain at baseline. Postoperative pain scores were lower among those who received dexmedetomidine compared to controls at 12 hours (p = 0.027), but there were no differences at any other time point. Time to first analgesic request was significantly longer in the dexmedetomidine and fentanyl group, and this time was longer in both dexmedetomidine groups compared to the control (p < 0.001). Total tramadol consumption also was lower among those who received dexmedetomidine (p < 0.001). In general, there was a lower prevalence of adverse effects among those receiving dexmedetomidine.

The intrathecal administration of 5 mcg dexmedetomidine increased the efficacy and duration of postoperative analgesia. The addition of fentanyl did not have a significant additive effect.

• Small sample (< 100)

The provision of preoperative intrathecal anesthetics and analgesics can improve postoperative pain control. This study demonstrated that the addition of dexmedetomidine to bupivacaine improved the postoperative effectiveness and duration of analgesia, resulting in less need for other analgesics. Nurses can advocate for the consideration of this type of approach for patients undergoing major surgery to reduce procedure-related pain.