Effects of epidurally administered dexmedetomidine and dexamethasone on postoperative pain, analgesic requirements, inflammation, and oxidative stress in thoracic surgery

1 J. P. Desborough, The stress response to trauma and surgery, Br. J. Anaesth. 85 (2000) 109–117; https://doi.org/10.1093/bja/85.1.109 Search in Google Scholar

2 C. C. Finnerty, N. T. Mabvuure, A. Ali, R. A. Kozar and D. N. Herndon, The surgically induced stress response, J. Parenter. Enter. Nutrition 37(5) (2013) 21S–29S; https://doi.org/10.1177/0148607113496117 Search in Google Scholar

3 D. J. Betteridge, What is oxidative stress?, Metabolism 49(2) (2000) 3–8; https://doi.org/10.1016/S0026-0495(00)80077-3 Search in Google Scholar

4 B. Kücükakin, I. Gögenur, R. J. Reiter and J. Rosenberg, Oxidative stress in relation to surgery: is there a role for the antioxidant melatonin?, J. Surg. Res. 152(2) (2009) 338–347; https://doi.org/10.1016/j.jss.2007.12.753 Search in Google Scholar

5 A. Sparks and J. R. Stewart, Review of pain management in thoracic surgery patients, J. Anesth. Clin. Res. 9(4) (2018) Article ID 817 (3 pages); https://doi.org/10.4172/2155-6148.1000817 Search in Google Scholar

6 P. M. Heerdt and D. F. Stowe, Single-lung ventilation and oxidative stress: a different perspective on a common practice, Curr. Opin. Anaesthesiol. 30(1) (2017) 42–49; https://doi.org/10.1097/ACO.0000000000000410 Search in Google Scholar

7 B. Shelley, A. Macfie and J. Kinsella, Anesthesia for thoracic surgery: a survey of UK practice, J. Cardiothorac. Vasc. Anesth. 25(6) (2011) 1014–1017; https://doi.org/10.1053/j.jvca.2011.06.018 Search in Google Scholar

8 S. C. Manion and T. J. Brennan, Thoracic epidural analgesia and acute pain management, Anesthesiology 115(1) (2011) 181–188; https://doi.org/10.1097/ALN.0b013e318220847c Search in Google Scholar

9 P. S. Chue and J. A. Chue, A review of the clinical uses of dexmedetomidine, Int. Clin. Anesthesiol. 5(4) (2017) Article ID 1080 (5 pages); https://doi.org/10.47739/2333-6641/1080 Search in Google Scholar

10 C. R. Patel, S. R. Engineer, B. J. Shah and S. Madhu, Effect of intravenous infusion of dexmedetomi-dine on perioperative haemodynamic changes and postoperative recovery: A study with entropy analysis, Indian J. Anaesth. 56(6) (2012) 542–546; https://doi.org/10.4103/0019-5049.104571 Search in Google Scholar

11 S. Junichi and M. Daqing, Can dexmedetomidine protect against surgical stress response?, Clin. Transl. Med. 10 (2020) e96 (2 pages); https://doi.org/10.1002/ctm2.96 Search in Google Scholar

12 K. Wang, M. Wu, J. Xu, C. Wu, B. Zhang, G. Wang and D. Ma, Effects of dexmedetomidine on peri-operative stress, inflammation, and immune function: systematic review and meta-analysis, Br. J. Anaesth. 123(6) (2019) 777–794; https://doi.org/10.1016/j.bja.2019.07.027 Search in Google Scholar

13 M. H. Kim, K. Y. Lee, S. J. Bae, M. Jo and J. S. Cho, Intraoperative dexmedetomidine attenuates stress responses in patients undergoing major spine surgery, Minerva Anestesiol. 85(5) 2018 468–477; http://dx.doi.org/10.23736/S0375-9393.18.12992-0 Search in Google Scholar

14 S. Naaz and E. Ozair, Dexmedetomidine in current anaesthesia practice – a review, J. Clin. Diagn. Res. 8(10) (2014) GE01–4; https://doi.org/10.7860/JCDR/2014/9624.4946 Search in Google Scholar

15 X. Zeng, J. Jiang, L. Yang and W. Ding, Epidural dexmedetomidine reduces the requirement of propofol during total intravenous anaesthesia and improves analgesia after surgery in patients undergoing open thoracic surgery, Sci. Rep. 7(1) (2017) Article ID 3992 (9 pages); https://doi.org/10.1038/s41598-017-04382-5 Search in Google Scholar

16 M. M. Elshal, R. M. Gamal, A. M. Ahmed, N. M. Gouda and M. M. Abdelhaq, Efcacy of adding dexmedetomidine as adjuvant with bupivacaine in ultrasoundguided erector spinae plane block for post thoracotomy pain: Randomized controlled study, Egypt. J. Anaesth. 37 (2021) 425–431; https://doi.org/10.1080/11101849.2021.1975973 Search in Google Scholar

17 D. Agamohammdi, M. Montazer,M. Hoseini, M. Haghdoost and H. Farzin, A comparison of continuous thoracic epidural analgesia with bupivacaine versus bupivacaine and dexmedetomidine for pain control in patients with multiple rib fractures, Anesth. Pain Med. 8(2) (2018) e60805 (7 pages); https://doi.org/10.5812/aapm.60805 Search in Google Scholar

18 B. Cekic, S. Geze, G. Ozkan, A. Besir, M. Sonmez, S. C. Karahan and A. Mentese, The effect of dexmedetomidine on oxidative stress during pneumoperitoneum, Biomed. Res. Int. 2014 (2014) Article ID 760323 (5 pages); http://dx.doi.org/10.1155/2014/760323 Search in Google Scholar

19 S. Gao, Y. Wang, J. Zhao and A. Su, Effects of dexmedetomidine pretreatment on heme oxygenase-1 expression and oxidative stress during one-lung ventilation, Int. J. Clin. Exp. Pathol. 8(3) (2015) 3144–3149; www.ijcep.com/ISSN:1936-2625 Search in Google Scholar

20 L. Yu, X. Shen and H. Liu, The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials, BMC Anesthesiol. 23(1) (2023) Article ID 61 (11 pages); http://dx.doi.org/10.1186/s12871-023-02019-x Search in Google Scholar

21 T. Rhen and J. A. Cidlowski, Antiinflammatory action of glucocorticoids – new mechanisms for old drugs, N. Engl. J. Med. 353(16) (2005) 1711–1723; https://doi.org/10.1056/NEJMra050541 Search in Google Scholar

22 Y. Y. Jo, J. H. Yoo, H. J. Kim and H. K. Kil, The effect of epidural administration of dexamethasone on postoperative pain: a randomized controlled study in radical subtotal gastrectomy, Korean J. Anesthesiol. 61(3) (2011) 233–237; https://doi.org/10.4097/kjae.2011.61.3.233 Search in Google Scholar

23 B. Jebaraj, P. Khanna, D. K. Baidya and S. Maitra, Efficacy of epidural local anesthetic and dexamethasone in providing postoperative analgesia: A meta-analysis, Saudi J. Anaesth. 10(3) (2016) 322–327; https://doi.org/10.4103/1658-354X.179096 Search in Google Scholar

24 H. F. Khafagy, A. I. Refaat, H. H. El-Sabae and M. A. Youssif, Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia, J. Anesth. 24(4) (2010) 531–536; https://doi.org/10.1007/s00540-010-0949-7 Search in Google Scholar

25 S. Thomas and S. Beevi, Epidural dexamethasone reduces postoperative pain and analgesic requirements, Can. J. Anaesth. 53(9) (2006) 899–905; https://doi.org/10.1007/BF03022833 Search in Google Scholar

26 A. F. Hefni, M. S. Mahmoud and A. A. Al Alim, Epidural dexamethasone for postoperative analgesia in patients undergoing abdominal hysterectomy: A dose ranging and safety evaluation study, Saudi J. Anaesth. 8(3) (2014) 323–327; https://doi.org/10.4103/1658-354X.136420 Search in Google Scholar

27 M. R. Razavizadeh, M. R. Fazel, N. Heydarian and F. Atoof, Epidural dexamethasone for postoperative analgesia in patients undergoing unilateral inguinal herniorrhaphy: A comparative study, Pain Res. Manag. 2017 (2017) Article ID 7649458 (6 pages); https://doi.org/10.1155/2017/7649458 Search in Google Scholar

28 N. Y. Kim, T. D. Kwon, S. J. Bai, S. H. Noh, J. H Hong, H. Lee and K. Y. Lee, Effects of dexmedetomi-dine in combination with fentanyl-based intravenous patient-controlled analgesia on pain attenuation after open gastrectomy in comparison with conventional thoracic epidural and fentanyl-based intravenous patient-controlled analgesia, Int. J. Med. Sci. 14(10) (2017) 951–960; https://doi.org/10.7150/ijms.20347 Search in Google Scholar

29 A. Gurbet, E. Basagan-Mogol. G. Turker, F. Ugun, F. N. Kaya and B. Ozcan, Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements, Can. J. Anaesth. 53(7) (2006) 646–652, https://doi.org/10.1007/BF03021622 Search in Google Scholar

30 J. M. Hong, K. H. Kim, H. J. Lee, J. Y. Kwon, H. K. Kim, H. J. Kim, A. R. Cho, W. S. Do and H. S. Kim, Epidural dexamethasone influences postoperative analgesia after major abdominal surgery, Pain Physician. 20(4) (2017) 261–269. Search in Google Scholar

31 X. Zeng, H. Wang, X. Xing, Q. Wang and W. Li, Dexmedetomidine protects against transient global cerebral ischemia/reperfusion induced oxidative stress and inflammation in diabetic rats, PLoS ONE 11(3) (2016) e0151620 (15 pages); https://doi.org/10.1371/journal.pone.0151620 Search in Google Scholar

32 H. A. Nounou, M. M. Deif and M. Arafah, The influence of dexamethasone and the role of some antioxidant vitamins in the pathogenesis of experimental bronchial asthma, J. Exp. Pharmacol. 2 (2010) 93–103; https://doi.org/10.2147/jep.s8313 Search in Google Scholar

33 E. Seljeskog, T. Hervig and M. A. Mansoor, A novel HPLC method for the measurement of thiobarbituric acid reactive substances (TBARS). A comparison with a commercially available kit, Clin. Biochem. 39(9) (2006) 947–954; https://doi.org/10.1016/j.clinbiochem.2006.03.012 Search in Google Scholar

34 I. Duka, M. Gerić, G. Gajski, M. Friščić, Ž. Maleš, A-M. Domijan and P. Turčić, Optimization of a fast screening method for the assessment of low molecular weight thiols in human blood and plasma suitable for biomonitoring studies, J. Environ. Sci. Health, A Tox. Hazard Subst. Environ. Eng. 55(3) (2020) 275–280; https://doi.org/10.1080/10934529.2019.1687236 Search in Google Scholar

35 A-M. Domijan, J. Ralić, S. Radić Brkanac, L. Rumora and T. Žanić-Grubišić, Quantification of malondialdehyde by HPLC-FL – application to various biological samples, Biomed. Chromatogr. 29(1) (2015) 41–46; https://doi.org/10.1002/bmc.3361 Search in Google Scholar

36 I. Dalle-Donne, R. Rossi, D. Giustarini, A. Milzani and R. Colombo, Protein carbonyl groups as biomarkers of oxidative srress, Clin. Chim. Acta 329(1–2) (2003) 23–38; https://doi.org/10.1016/s0009-8981(03)00003-2 Search in Google Scholar

37 S. Agarwal, R. Verma, A. Shukla, Hemlata, D. Singh and A. K. Chaudhary, Effect of dexmedetomi-dine on hemodynamics in thoracic surgery – A randomized controlled study, J. Clin. Res. Appl. Med. 1(1) (2021) 2–6; https://doi.org/10.5530/jcram.1.1.2 Search in Google Scholar

38 Y. Zhao, J. He, N. Yu, C. Jia and S. Wang, Mechanisms of dexmedetomidine in neuropathic pain, Front Neurosci. 14 (2020) 330–430; https://doi.org/10.3389/fnins.2020.00330 Search in Google Scholar

39 M. A. Hamed, O. S. Fargaly, R. A. Abdelghaffar, M. A. Moussa and M. F. Algyar, The role of dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study, BMC Anesthesiol. 23 (2023) Article ID 53 (7 pages); https://doi.org/10.1186/s12871-023-02014-2 Search in Google Scholar

40 C. Song and Q. Lu, Effect of dexmedetomidine supplementation for thoracoscopic surgery: a meta-analysis of randomized controlled trials, J. Cardiothorac. Surg. 17 (2022) Article ID 70 (8 pages); https://doi.org/10.1186/s13019-022-01803-z Search in Google Scholar

41 M. H. Bakri, E. A. Ismail and A. Ibrahim, Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy, Korean J. Anesthesiol. 68(3) 2015 254–260; http://dx.doi.org/10.4097/kjae.2015.68.3.254 Search in Google Scholar

42 A. Mazy, M. Gad and M. Bedairy, Preperitoneal postcesarean section bupivacaine analgesia: Comparison between dexamethasone and dexmedetomidine as adjuvants, Saudi J. Anaesth. 12(2) 2018 183–189; https://doi.org/10.4103/sja.SJA_450_17 Search in Google Scholar

43 N. M. Bulow, E. Colpo, R. P. Pereira, E. F. Correa, E. P. Waczuk, M. F. Duarte and J. B. Rocha, Dexmedetomidine decreases the inflammatory response to myocardial surgery under mini-cardiopulmonary bypass, Braz. J. Med. Biol Res. 49(4) (2016) e4646 (7 pages); http://dx.doi.org/10.1590/1414-431X20154646 Search in Google Scholar

44 J. Pizzorno, Glutathione!, Integr. Med. (Encinitas) 13(1) (2014) 8–12. Search in Google Scholar

45 O. M. Ighodaro and O. A. Akinloye, First line defence antioxidants-superoxide dismutase (SOD), catalase(CAT) and glutathione peroxidase (GPX): Their fundamental role in the entire antioxidant defence grid, Alexandria J. Med. 54(4) (2018) 287–293; https://doi.org/10.1016/j.ajme.2017.09.001 Search in Google Scholar

46 S. Li, Y. Yang, C. Yu, Y. Yao, Y. Wu, L. Qian and C. W. Cheung, Dexmedetomidine analgesia effects in patients undergoing dental implant surgery and its impact on postoperative inflammatory and oxidative stress, Oxidat. Med. Cell. Longevity 2015 (2015) Article ID 186736 (11 pages); http://dx.doi.org/10.1155/2015/186736 Search in Google Scholar

47 B. Schick, B. Mayer, S. Walter, S. Gruss, R. Stitz, P. Stitz and E. Barth, Measurement of the nociceptive flexion reflex threshold in critically ill patients – a randomized observational pilot study, BMC Anesthesiol. 21 (2021) Article ID 270 (13 pages); https://doi.org/10.1186/s12871-021-01490-8 Search in Google Scholar