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

[La dexmédétomidine combinée à la morphine en AAC fournit une analgésie supérieure pour la lithotripsie par ondes de choc]

From the Department of Anesthesia and Critical Care Medicine, King Abdulaziz University, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Address correspondence to: Dr. Jamal A. Alhashemi, P.O. Box 31648, Jeddah 21418, Saudi Arabia. Phone: +966-2-6408335; Fax: +966-2-6408336; E-mail: jalhashemi{at}kaau.edu.sa

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 µg•kg^–1 iv followed by 0.5 µg•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 µg•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.

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