Comparison of patient-controlled analgesia with and without dexmedetomidine following spine surgery in children.
OBJECTIVE
To evaluate the effect of dexmedetomidine as an adjunct to patient-controlled analgesia (PCA) with morphine.


METHODS
Retrospective comparison.


METHODS
University-affiliated children's hospital.


METHODS
The medical charts of 131 children with idiopathic scoliosis (IS) and NMS who had major spine surgery were reviewed. Out of 131, postoperatively 94 children received PCA with morphine alone (PCA group) and the remaining 37 children received PCA morphine and dexmedetomidine infusion at 0.4 mcg/kg/hour for 24 hours (PCA + Dex group). Preoperative, intraoperative, and postoperative morphine use data were collected.


RESULTS
Intraoperative use of morphine was similar in children with IS and NMS. However, patients with IS used more morphine than patients with NMS on the first, second and third postoperative days in both groups. In children with IS, use of morphine on the second postoperative day was significantly higher in the PCA + Dex group (73 mg [50.5, 110.5]) than the PCA alone group (54 mg [36, 69], P = 0.03). The overall frequency of all perioperative complications was more in the PCA alone group (40% vs. 32%) than the PCA + Dex group.


CONCLUSIONS
Postoperative 24-hour dexmedetomidine infusion as an adjunct to PCA with opioids might have a morphine-sparing effect as evidenced by the increase in morphine use on postoperative day 2 after the dexmedetomidine infusion was stopped.
Sadhasivam
Senthilkumar
S
Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, MLC 2001, Cincinnati, OH 45229, USA. senthilkumar.sadhasivam@cchmc.org
Boat
Anne
A
Mahmoud
Mohamed
M
D000293:Adolescent; D016058:Analgesia, Patient-Controlled; D000771:Anesthesia, Intravenous; D003422:Critical Care; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy / Q000453:epidemiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000453:epidemiology; D012600:Scoliosis / Q000601:surgery; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine