title: Epidural Co-Administration of Dexmedetomidine and Levobupivacaine Improves the Gastrointestinal Motility Function after Colonic Resection in Comparison to Co-Administration of Morphine and Levobupivacaine.
abstract: Gastrointestinal motility may be impaired after intestinal surgery. Epidural morphine is effective in controlling postoperative pain, but can further reduce gastrointestinal motility. Here, we aimed to investigate the effects of epidural dexmedetomidine on gastrointestinal motility in patients undergoing colonic resection. Seventy-four patients undergoing colonic resection were enrolled in this clinical trial and allocated randomly to treatment with dexmedetomidine (D group) or morphine (M group). The D group received a loading dose epidural administration of 3 ml dexmedetomidine (0.5 μg kg(-1)) and then a continuous epidural administration of 80 μg dexmedetomidine in 150 ml levobupivacaine (0.125%) at 3 ml h(-1) for two days. The M group received a loading dose epidural administration of 3 ml morphine (0.03 mg kg(-1)) and then a continuous epidural administration of 4.5 mg morphine in 150 ml levobupivacaine at 3 ml h(-1) for two days. Verbal rating score (VRS), postoperative analgesic requirements, side effects related to analgesia, the time to postoperative first flatus (FFL) and first feces (FFE) were recorded. VRS and postoperative analgesic requirements were not significantly different between treatment groups. In contrast, the time to FFL and time to FFE were significant longer in M group in comparison to D group (P < 0.05). Moreover, patients in M group had a significantly higher incidence of nausea, vomiting, and pruritus (P < 0.05). No patients showed neurologic deficits in either group. In comparison to morphine, epidural dexmedetomidine is safe and beneficial for the recovery of gastrointestinal motility after colonic resection when used as an adjunct with levobupivacaine for postoperative pain control.
  
  
  BACKGROUND
  Chinese Clinical Trial Registry ChiCTR-TRC-14004644.
authors.affiliation: Department of Anesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
authors.forename: Xian-Zhang
authors.initials: XZ
authors.lastname: Zeng
authors.affiliation: Department of Anesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
authors.forename: Zhi-Fang
authors.initials: ZF
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
authors.forename: Xiang-Qi
authors.initials: XQ
authors.lastname: Lv
authors.affiliation: Department of Anesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
authors.forename: Yue-Ping
authors.initials: YP
authors.lastname: Guo
authors.affiliation: Department of Anesthesiology, Second Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, 150001, Heilongjiang, China.
authors.forename: Xiao-Guang
authors.initials: XG
authors.lastname: Cui
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003106:Colon / Q000187:drug effects / Q000601:surgery*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods; D005243:Feces; D005260:Female; D005414:Flatulence; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000628:therapy; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D020927:Dexmedetomidine; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine