title: Dexmedetomidine-fentanyl Compared With Midazolam-fentanyl for Conscious Sedation in Patients Undergoing Lumbar Disc Surgery.
abstract: OBJECTIVE
  Patients undergoing awake lumbar disc surgery need adequate sedation and analgesia. This study investigated whether use of a dexmedetomidine-fentanyl (DF) regimen could be superior to midazolam-fentanyl (MF) for these patients.
  
  
  METHODS
  Sixty patients scheduled for elective lumbar laminotomy and discectomy were randomly assigned to receive either DF or MF for conscious sedation. Patient-controlled intravenous analgesia with fentanyl was used for postoperative pain management. Hemodynamic and respiratory changes, sedation scores, pain scores, fentanyl consumption, patient satisfaction, postoperative hospital stay, and adverse events were assessed.
  
  
  RESULTS
  The patient and surgical characteristics, sedation levels, and pain scores were similar in the 2 groups. Compared with the MF group, heart rate was lower in the DF group at six time points from skin incision to 15 minutes in the postanesthesia care unit (PACU), they are skin incision, 15 min after the beginning of surgery, 30 min after the beginning of surgery, skin closure, entering PACU, and 15 min in PACU (P = 0.016, 0.002, 0.000, 0.000, 0.000, and 0.001, respectively), whereas pulse oxygen saturation was higher at 3 time points from 15 minutes after the beginning of surgery to skin closure (P = 0.022, 0.026, and 0.025, respectively). The intraoperative, postoperative, and total consumption of fentanyl were lower in the DF group (total: mean difference = -69.3 µg; 95% CI, = -114.3 to -24.4; P = 0.003). No significant differences were found for adverse events, postoperative hospital stay, or satisfaction between the 2 groups.
  
  
  CONCLUSIONS
  Although awake lumbar disc surgery can be performed successfully under sedation with either MF or DF combination, the latter may be a better alternative because of less consumption of opioid analgesics. ChiCTR.org identifier: ChiCTR-TRC-13003645.
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Peng
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Hua-Yue
authors.initials: HY
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Si-Lan
authors.initials: SL
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China. Electronic address: jifuhaisuda@163.com.
authors.forename: Fu-Hai
authors.initials: FH
authors.lastname: Ji
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D017586:Diskectomy / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007796:Laminectomy / Q000009:adverse effects; D007902:Length of Stay; D008159:Lumbar Vertebrae; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D017060:Patient Satisfaction; D011184:Postoperative Period
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl
keywords: analgesia; dexmedetomidine; discectomy; laminotomy; midazolam; sedation