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Changing Pain Management Strategy from Opioid-centric Towards Improve Postoperative Cognitive Dysfunction with Dexmedetomidine.
Current Drug Metabolism ( IF 2.3 ) Pub Date : 2022-01-01 , DOI: 10.2174/1389200222666211118115347
Chunhong Su 1 , Xiaojun Ren 2 , Hongpei Wang 1 , Xiaomei Ding 1 , Jian Guo 1
Affiliation  

OBJECTIVE This study was aimed to investigate the effectiveness of dexmedetomidine (DEX) on improving the level of pain and disability to find out the possible correlation between psychological factors with pain management satisfaction and physical function in patients with femoral neck fractures. METHODS One hundred twenty-four adult patients with stable femoral neck fractures (type I and II, Garden classification) who underwent internal fixation, were prospectively enrolled including 62 patients in the DEX group and 62 patients in the control group. The magnitude of disability using Harris Hip Score, Postoperative Cognitive Dysfunction (POCD) using Mini-Mental State Examination (MMSE score), Quality of Recovery (QoR-40), pain-related anxiety (PASS-20), pain management and pain catastrophizing scale (PCS) were recorded on the first and second day after surgery. RESULTS The DEX group on the first and second days after surgery exhibited higher quality of recovery scores, greater satisfaction with pain management, low disability scores, less catastrophic thinking, lower pain anxiety, greater mini mental state examination scores and less opioid intake and the differences were statistically significant compared with the control group (P<0.001). Emergence agitation and incidence of POCD were significantly less in the DEX group (P<0.001). Decreased disability was associated with less catastrophic thinking and lower pain anxiety, but not associated with more opioid intake (P<0.001). Higher QoR-40 scores had a negative correlation with more catastrophic thinking and more opioid intake (P<0.001). Greater satisfaction with pain management was correlated with less catastrophic thinking and less opioid intake (P<0.001). CONCLUSION Using DEX as an adjunct to anesthesia could significantly improve postoperative cognitive dysfunction and the quality of recovery and these improvements were accompanied by decrease in pain, emergence agitation, and opioid consumption by DEX administration. Since pain relief and decreased disability were not associated with prescribing greater amounts of opioid intake in the patients, improving psychological factors, including reducing catastrophic thinking or self-efficacy about pain, could be a more effective strategy to reduce pain and disability, meanwhile reducing opioid prescription in the patients. Our findings showed that DEX administration is safe sedation with anti-inflammatory, analgesic and antiemetic effects and it could help change pain management strategy from opioidcentric towards improved postoperative cognitive dysfunction.

中文翻译:

将疼痛管理策略从以阿片类药物为中心转变为使用右美托咪定改善术后认知功能障碍。

目的 本研究旨在探讨右美托咪定(DEX)在改善股骨颈骨折患者疼痛和残疾水平方面的有效性,探讨心理因素与疼痛管理满意度和躯体功能的可能相关性。方法前瞻性入组124例接受内固定治疗的稳定型股骨颈骨折(I型和II型,Garden分类)成人患者,其中DEX组62例,对照组62例。使用哈里斯髋关节评分的残疾程度,使用简易精神状态检查(MMSE 评分)的术后认知功能障碍(POCD),恢复质量(QoR-40),疼痛相关焦虑(PASS-20),在手术后的第一天和第二天记录疼痛管理和疼痛灾难化量表(PCS)。结果 DEX组术后第1天和第2天恢复质量评分较高,对疼痛管理的满意度较高,残疾评分较低,灾难性思维较少,疼痛焦虑较低,迷你精神状态检查评分较高,阿片类药物摄入较少及差异与对照组相比有统计学意义(P<0.001)。在 DEX 组中,出现躁动和 POCD 的发生率显着降低(P<0.001)。残疾减少与较少的灾难性思维和较低的疼痛焦虑相关,但与更多的阿片类药物摄入无关(P<0.001)。较高的 QoR-40 评分与更多的灾难性思维和更多的阿片类药物摄入呈负相关(P<0. 001)。对疼痛管理的更高满意度与更少的灾难性思维和更少的阿片类药物摄入相关(P<0.001)。结论 使用 DEX 作为麻醉辅助可以显着改善术后认知功能障碍和恢复质量,并且这些改善伴随着 DEX 给药后疼痛、苏醒激动和阿片类药物消耗的减少。由于减轻疼痛和减少残疾与给患者开出更多的阿片类药物摄入量无关,因此改善心理因素,包括减少对疼痛的灾难性思维或自我效能感,可能是减轻疼痛和残疾的更有效策略,同时减少阿片类药物给患者开处方。我们的研究结果表明,DEX 给药是安全的镇静剂和抗炎剂,
更新日期:2021-11-17
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