Analgesic Efficacy of Fentanyl versus Dexmedetomidine for Postoperative Pain Management Following Posterior Spinal Stabilization Surgery: A Prospective Comparative Study at Dr. Zainoel Abidin General Hospital, Banda Aceh
DOI:
https://doi.org/10.59784/glosains.v7i2.702Keywords:
fentanyl, dexmedetomidine, posterior stabilization, postoperative bread, NLR, PLR, hemodynamic stabilityAbstract
Background: Posterior spinal stabilization is a major surgical procedure associated with significant postoperative pain. Effective analgesia is essential to prevent excessive physiological stress, hemodynamic instability, and postoperative inflammatory responses. Fentanyl and dexmedetomidine are commonly used analgesics, yet comparative evidence in posterior stabilization surgery remains inconsistent.
Objective: This study aimed to evaluate the effectiveness of both agents in terms of analgesia, hemodynamic stability, and inflammatory biomarkers (NLR, PLR).
Methods: A prospective comparative study was conducted on 16 patients undergoing posterior spinal stabilization at Dr. Zainoel Abidin General Hospital. Patients were allocated into two postoperative analgesia groups: fentanyl (2 mcg/kg bolus followed by 1 mcg/kg/h infusion) and dexmedetomidine (1 mcg/kg bolus followed by 0.4 mcg/kg/h infusion). Pain intensity (NRS), hemodynamics (HR, SBP, DBP, RR, SpO₂), and inflammatory markers (NLR, PLR) were assessed at 2, 6, 12, 24, and 48 hours postoperatively.
Results: Baseline characteristics were comparable between groups (p > 0.05). Both groups demonstrated significant reductions in postoperative pain from 2 to 48 hours. No clinically meaningful differences in NRS were found, except at 12 hours (p = 0.011), which was not sustained at later time points. Hemodynamic parameters remained stable; differences in diastolic blood pressure at 24 and 48 hours were statistically significant but clinically negligible. NLR and PLR values decreased progressively in both groups, with no significant intergroup differences.
Conclusion: Fentanyl and dexmedetomidine provide comparable analgesic efficacy, hemodynamic stability, and inflammatory modulation in postoperative management following posterior spinal stabilization. Both agents are safe and effective for postoperative analgesia in this setting.
References
Ahmed, W. N., & Khan, A. W. (2022). Use of dexmedetomidine for anesthesia and pain management: An updated review of literature. Anaesth Pain Intensive Care, 1, 26. https://doi.org/10.35975/apic.v26i5.2020
Alsultan, D. (2024). Efficacy of dexmedetomidine as an adjuvant in transverse abdominal plane blocks for cesarean section pain management: A systematic review and meta-analysis. Saudi Journal of Anaesthesia, 18(4), 545–555. https://doi.org/10.4103/sja.sja_306_24
Cooney, M., & Quinlan-Colwell, A. (2020). Assessment and multimodal management of pain: an integrative approach. Elsevier Health Sciences.
Ding, X., Luo, Y., Shi, L., Liu, C., & Yan, Z. (2021). Butorphanol in combination with dexmedetomidine provides efficient pain management in adult burn patients. Burns, 47(7), 1594–1601. https://doi.org/10.1016/j.burns.2020.12.025
Inose, H., Kato, T., Sasaki, M., Matsukura, Y., Hirai, T., Yoshii, T., Kawabata, S., Hirakawa, A., & Okawa, A. (2022). Comparison of decompression, decompression plus fusion, and decompression plus stabilization: a long-term follow-up of a prospective, randomized study. The Spine Journal, 22(5), 747–755. https://doi.org/10.1016/j.spinee.2021.12.014
Kodali, V. R. K., Shree, S., Prasad, M., Sambandam, K. K. G., Karthekeyan, R. B., & Vakamudi, M. (2022). A comparative study of bilateral erector spinae block versus intravenous dexmedetomidine for perioperative pain management in patients undergoing off-pump coronary artery bypass grafting-A single-blind randomized controlled trial. Journal of Cardiothoracic and Vascular Anesthesia, 36(11), 4085–4092. https://doi.org/10.1053/j.jvca.2022.07.015
Liu, N., Liu, G., Chang, X., Xu, Y., Hou, Y., Zhang, D., Wang, L., & Chen, S. (2024). Combining various acupuncture therapies with multimodal analgesia to enhance postoperative pain management following total knee arthroplasty: a network meta-analysis of randomized controlled trials. Frontiers in Neurology, 15, 1361037.
Liu, X., Li, Y., Kang, L., & Wang, Q. (2021). Recent advances in the clinical value and potential of dexmedetomidine. Journal of Inflammation Research, 7507–7527. https://doi.org/10.2147/JIR.S346089
Macintyre, P. E., Quinlan, J., Levy, N., & Lobo, D. N. (2022). Current issues in the use of opioids for the management of postoperative pain: a review. JAMA Surgery, 157(2), 158–166.
Moharari, R. S., Shahinpour, S., Saeedi, N., Sahraei, E., Najafi, A., Etezadi, F., Khajavi, M., Ahmadi, A., & Pourfakhr, P. (2021). Comparison of intraoperative infusion of remifentanil versus fentanyl on pain management in patients undergoing spine surgery: A double blinded randomized clinical trial. Anesthesiology and Pain Medicine, 11(4), e115576. https://doi.org/10.5812/aapm.115576
Nugent, S. M., Lovejoy, T. I., Shull, S., Dobscha, S. K., & Morasco, B. J. (2021). Associations of pain numeric rating scale scores collected during usual care with research administered patient reported pain outcomes. Pain Medicine, 22(10), 2235–2241.
Park, R., Mohiuddin, M., Arellano, R., Pogatzki-Zahn, E., Klar, G., & Gilron, I. (2023). Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis. Pain Reports, 8(3), e1075. https://doi.org/10.1097/PR9.0000000000001075
Paul, A. (2021). Adrenergic agonists. In Introduction to Basics of Pharmacology and Toxicology: Volume 2: Essentials of Systemic Pharmacology: From Principles to Practice (pp. 41–53). Springer.
Rathee, A., Chaurasia, M. K., Singh, M. K., Singh, V., Kaushal, D., Chaurasiya, M. K., & KAUSHAL, D. (2023). Relationship between pre-and post-operative C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) with post-operative pain after total hip and knee arthroplasty: An observational study. Cureus, 15(8). https://doi.org/10.7759/cureus.43782
Shafshak, T. S., & Elnemr, R. (2021). The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain. JCR: Journal of Clinical Rheumatology, 27(7), 282–285. https://doi.org/10.1097/RHU.0000000000001320
Show, K. L., Ngamjarus, C., Kongwattanakul, K., Rattanakanokchai, S., Duangkum, C., Bohren, M. A., Betrán, A. P., Somjit, M., Win, W. Y. H., & Lumbiganon, P. (2022). Fentanyl for labour pain management: a scoping review. BMC Pregnancy and Childbirth, 22(1), 846. https://doi.org/10.1186/s12884-022-05169-x
Suarjaya, I. P. P. (2023). Effectiveness of Postoperative Pain Management and Postoperative Emergency Pain Management at Prof. Dr. IGNG Ngoerah General Hospital. Majalah Anestesia & Critical Care, 41(1), 30–35. https://doi.org/10.55497/majanestcricar.v41i1.295
Wang, K., Wu, M., Xu, J., Wu, C., Zhang, B., Wang, G., & Ma, D. (2019). Effects of dexmedetomidine on perioperative stress, inflammation, and immune function: systematic review and meta-analysis. British Journal of Anaesthesia, 123(6), 777–794. https://doi.org/10.1016/j.bja.2019.07.027
Xu, W., Zheng, Y., Suo, Z., Fei, K., Wang, Y., Liu, C., Li, S., Zhang, M., Zhang, Y., & Zheng, Z. (2022). Effect of dexmedetomidine on postoperative systemic inflammation and recovery in patients undergoing digest tract cancer surgery: a meta-analysis of randomized controlled trials. Frontiers in Oncology, 12, 970557. https://doi.org/10.3389/fonc.2022.970557
Yudianto, K., & Fernanda, N. P. M. (2024). Evaluation of Pain Management in Post-Spinal Decompression and Posterior Stabilization Patients: Case Study. Journal of Nursing Care, 7(2), 87–95. https://doi.org/10.24198/jnc.v7i2.45423
Zhao, Y., He, J., Yu, N., Jia, C., & Wang, S. (2020). Mechanisms of dexmedetomidine in neuropathic pain. Frontiers in Neuroscience, 14, 330. https://doi.org/10.3389/fnins.2020.00330
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