The Effect of Intraoperative Dexmedetomidine Versus Morphine on Postoperative Morphine Requirements After Laparoscopic Bariatric Surgery.

Abstract

BACKGROUND\nDexmedetomidine is an α2 receptor agonist with sedative and analgesic properties. During bariatric surgery, its use may reduce postoperative opioid requirements, reduce their side effects, and improve quality of recovery. The aim of this prospective randomized controlled trial was to compare the effect of dexmedetomidine bolus and infusion versus morphine bolus given prior to the end of laparoscopic bariatric surgery.\n\n\nMETHODS\nSixty morbidly obese patients (BMI\u2009>\u200940\xa0kg\xa0m-2) aged 18 to 60\xa0years, undergoing laparoscopic sleeve gastrectomy, received morphine sulfate (bolus 0.08\xa0mg\xa0kg-1 followed by a saline infusion) (group M, n\u2009=\u200930) or dexmedetomidine (loading dose of 1\xa0μg\xa0kg-1 followed by 0.5\xa0μg\xa0kg-1\xa0h-1) (group D, n\u2009=\u200930) 30\xa0min before the end of surgery. Data collected included morphine consumption in the post-anesthesia care unit (PACU) (primary outcome) and at 24\xa0h, pain intensity, nausea, heart rate, blood pressure, vomiting, sedation, and quality of recovery.\n\n\nRESULTS\nThere was no significant difference in morphine consumption in the PACU (group D 12.2\u2009±\u20095.44\xa0mg, group M 13.28\u2009±\u20096.64\xa0mg, P\u2009=\u20090.54) or at 24\xa0h (group D 40.67\u2009±\u200924.78\xa0mg, group M 43.28\u2009±\u200927.79\xa0mg, P\u2009=\u20090.75); when accounting for intraoperative morphine given group M had significantly higher morphine consumption when compared to group D (23.48\u2009±\u20096.22\xa0mg vs. 12.22\u2009±\u20095.54\xa0mg, respectively, P\u2009<\u20090.01). Group D patients had more cardiovascular stability.\n\n\nCONCLUSIONS\nDexmedetomidine given prior to end of laparoscopic sleeve gastrectomy provides the same level of postoperative analgesia as morphine with better hemodynamic profile.