Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

• Published in: Current pain and headache reports Vol. 24; no. 5; p. 21
• Main Authors: Kaye, Alan David, Chernobylsky, David J., Thakur, Pankaj, Siddaiah, Harish, Kaye, Rachel J., Eng, Lauren K., Harbell, Monica W., Lajaunie, Jared, Cornett, Elyse M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2020; Springer Nature B.V
• Subjects: Analgesics; Analgesics, Non-Narcotic - therapeutic use; Anesthesia; Anesthesiology; Dexmedetomidine - therapeutic use; Drug dosages; Enhanced Recovery After Surgery; Humans; Internal Medicine; Medical personnel; Medicine; Medicine & Public Health; Metabolism; Narcotics; Other Pain (AD Kaye and N Vadivelu; Other Pain (AD Kaye and N Vadivelu, Section Editors); Pain; Pain management; Pain Management - methods; Pain Medicine; Pain, Postoperative - prevention & control; Patient satisfaction; Postoperative period; Proteins; Recovery (Medical); Section Editors; Surgery; Topical Collection on Other Pain; Alpha 2 antagonists; Clonidine; Chronic pain; Dexmedetomidine; ERAS
• ISSN: 1531-3433; 1534-3081; 1534-3081
• DOI: 10.1007/s11916-020-00853-z

Purpose of Review Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30–50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU). Recent Findings Dexmedetomidine, a selective alpha 2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Summary Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.