The Effect of Adding Dexmedetomidine to Fentanyl for Pain Management after Spinal Fusion Surgery Using Intravenous Patient-Controlled Analgesia Pumps; A Clinical Trial Study

In spine surgeries, proper control of postoperative pain in patients is one of the main goals. Opioids use, due to fear of complications, is limited. Adding dexmedetomidine may be helpful in reducing opioids and their complications. This study aimed to assess the effect of adding dexmedetomidine to fentanyl for pain management after spinal fusion surgery using intravenous patient-controlled analgesia (PCA) pumps.

Patients undergoing spine surgeries were randomly categorized into two groups of fentanyl + dexmedetomidine and fentanyl + placebo. At the end of the surgery, PCA pump was set up for both groups and after bolus injection, dexmedetomidine (0.1 μg/kg) or equivalent volume of normal saline 0.9% were added to fentanyl at base dose of 0.5 μg/kg; afterward, infusion using PCA pump with specific setup was carried out for 24 hours after surgery. The measured parameters included postoperative pain intensity, additional opioid use and its relevant side effects, respiratory rate, heart rate, systolic, diastolic, and mean arterial pressure, used dexmedetomidine, and also the satisfaction of patients. The results were analyzed using SPSS software.

Adding dexmedetomidine to fentanyl, in addition to the significant decrease in pain, also reduced opioid use during the first 24 hours after surgery; which led to fewer side effects caused by opioids such as hypoxia, hypotension, bradycardia, nausea, vomiting, and sedation.

Dexmedetomidine in addition to base opioid (fentanyl) in PCA pumps can be used as a suitable and reliable drug with minimal side effects. It can provide patient sedation and satisfaction, and ease in the work of the intensive care unit (ICU) team.