Postoperative Continuous Infusion of Dexmedetomidine Did Not Improve Recovery of Gastrointestinal Function in Laparoscopic Colorectal Surgery: A Randomized Clinical Trial

Abstract

Objectives

To explore the effects of postoperative infusion of dexmedetomidine on the recovery of gastrointestinal function among patients undergoing laparoscopic colorectal surgery.

Methods

130 participants aged 18 to 75 years who were scheduled to receive laparoscopic colorectal surgery were enrolled. Dexmedetomidine infusion was conducted as a loading dose of 0.5 μg/kg over 15 minutes before skin scuffing followed by a dose of 0.05 μg/kg per hour at the end of surgery lasting 48h in dexmedetomidine group, while patients in the control group only received loading dose of 0.5 μg/kg. The primary outcome was time to first flatus. Secondary outcomes were postoperative gastrointestinal function measured by the I-FEED (intake, feeling nauseated, emesis, physical examination, and duration of symptoms) scoring system, time to first oral feeding, incidence of delirium, pain scores, sleep quality, postoperative anxiety states, postoperative nausea and vomiting and length of stay in hospital. Plasma samples were collected to test concentrations of C-reactive protein.

Results:

Among 130 patients enrolled, 60 were randomized to receive intraoperative dexmedetomidine, and 60 were randomized to receive placebo. There was no significant difference in time to first flatus (median, 59 hours [IQR, 50.5-66.9 hours] vs 63.5 hours [49.3-81.6 hours], respectively; P= 0.15), time to first feces (median, 86 hours [IQR, 68-115 hours] vs 70.3 hours [IQR, 56.1-95.5 hours]; P =0.43), and time to first oral feeding (median, 77.5 hours [68.1-86.7] vs 79.3 [IQR, (67.6-100.4) ] P =0 .29). Postoperative gastrointestinal function (measured by the I-FEED score) and delirium incidence were similar in the dexmedetomidine and control group. Patients in the dexmedetomidine group had longer total sleep time and higher sleep efficiency than those in the control group.

Conclusion:

Postoperative continuous infusion of dexmedetomidine could improve the quality of sleep after laparoscopic colorectal surgery. However, postoperative dexmedetomidine infusing continuously after laparoscopic colorectal surgery did not improve recovery of gastrointestinal function.