Dexmedetomidine reduced the reliance on perioperative opioids in children who underwent adenotonsillectomy, but treatment with dexmedetomidine was associated with an increase in the duration of stay in the postanesthesia care unit (PACU), according to a study in Anesthesia & Analgesia.
The study included 941 children who underwent adenotonsillectomy at Texas Children’s Hospital between 2017 and 2018. In the overall cohort, a total of 697 (74.1%) patients received intraoperative dexmedetomidine.
Researchers evaluated the total perioperative opioid consumption, which was calculated as oral morphine equivalents (OME), between patients who did vs didn’t receive dexmedetomidine. Other outcomes of interest were opioid consumption and pain scores based on the presence and absence of obstructive sleep apnea as well as duration of PACU stay.
Patients who did not receive intraoperative dexmedetomidine had a greater mean total perioperative OME (0.56 vs 0.43 mg/kg; P <.001). Those who did not receive dexmedetomidine had a greater mean total OME in both the intraoperative (0.45 vs 0.35 mg/kg; P <.001) and postoperative (0.11 vs 0.08 mg/kg; P <.001) periods.
The total perioperative OME decreased by 0.021 mg/kg for every 0.1 μg/kg increase in intraoperative dexmedetomidine (95% CI, -0.027 to -0.015; P <.001). There was no significant variation in pain scores by OSA status, and there was no difference in postoperative opioid consumption in terms of surgical techniques. The PACU duration significantly increased 1.14 minutes (95% CI, 0.30-1.99; P =.008) for each 0.1 μg/kg of dexmedetomidine.
Limitations of this study included its retrospective nature as well as the lack of multivariable adjustment for some of the secondary outcome analyses.
Based on their findings, the investigators suggest dexmedetomidine “should be considered as part of an optimal analgesic strategy for children undergoing adenotonsillectomy.”
Adler AC, Daszkowski A, Tan JC, et al. The association of dexmedetomidine on perioperative opioid consumption in children undergoing adenotonsillectomy with and without obstructive sleep apnea. Anesth Analg. Published online January 15, 2021. doi:10.1213/ANE.0000000000005410