Dexmedetomidine in combination with morphine PCA provides superior analgesia for shockwave lithotripsy

Can J Anaesth. 2004 Apr;51(4):342-7. doi: 10.1007/BF03018237.

Abstract

Purpose: To compare the analgesic effects of dexmedetomidine/morphine with those of tramadol/midazolam in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for urinary calculi.

Methods: Sixty patients were randomized to receive either dexmedetomidine 1 micro g*kg(-1) iv followed by 0.5 micro g*kg(-1)*hr(-1) infusion together with morphine patient-controlled analgesia [(PCA); 2 mg bolus, five minutes lockout, 2 mg*hr(-1) infusion; (Group DEX)], or tramadol 1.5 mg*kg(-1) pre-mixed with midazolam 30 micro g*kg(-1) iv followed by tramadol PCA [20 mg bolus, five minute lockout, 20 mg*hr(-1) infusion; (Group TRA)]. Pain was assessed at baseline and every 15 min thereafter. Patients' and urologist's satisfaction with analgesia and sedation were determined on a seven-point scale ranging from 1 (extremely dissatisfied) to 7 (extremely satisfied). Patient's discharge time was also documented.

Results: Visual analogue scale scores over time were consistently lower in Group DEX compared with Group TRA (P = 0.001). Patients' satisfaction with analgesia (5 +/- 1 vs 4 +/- 2, P = 0.012) and with sedation (6 +/- 1 vs 5 +/- 1, P = 0.020), and urologist's satisfaction (6 +/- 1 vs 4 +/- 2, P = 0.001) were all higher amongst Group DEX patients compared with Group TRA. There was no difference between discharge times of patients in Group DEX compared with those in Group TRA [85 (60,115) min vs 65 (40,95) min, P = 0.069].

Conclusion: Dexmedetomidine in combination with morphine PCA provided better analgesia for ESWL and was associated with higher patients' and urologist's satisfaction when compared with a tramadol/midazolam PCA combination.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesia, Patient-Controlled / methods
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Anesthetics, Intravenous / therapeutic use
  • Dexmedetomidine / administration & dosage
  • Dexmedetomidine / therapeutic use*
  • Double-Blind Method
  • Drug Combinations
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Hypnotics and Sedatives / therapeutic use
  • Lithotripsy*
  • Male
  • Midazolam / therapeutic use*
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / therapeutic use*
  • Pain Measurement / methods
  • Pain, Postoperative / prevention & control*
  • Patient Satisfaction
  • Psychomotor Performance / drug effects
  • Time Factors
  • Tramadol / therapeutic use*

Substances

  • Analgesics, Opioid
  • Anesthetics, Intravenous
  • Drug Combinations
  • Hypnotics and Sedatives
  • Tramadol
  • Dexmedetomidine
  • Morphine
  • Midazolam