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DNP Project




Background: Opioid consumption is at an alarming rate in the United States. Their side effects have attracted debates on whether they are indispensable and continuously prompt further consideration of alternative approaches. Recent studies have suggested that dexmedetomidine has a good analgesic profile and can reduce opioid consumption. Additional studies are warranted to establish whether dexmedetomidine as an adjunct therapy can influence opioid consumption in surgical units.

Objectives: This literature review aimed to evaluate the current randomized controlled trials (RCTs) on the impact of dexmedetomidine as adjunct therapy on opioid consumption and further recommend best available practices on the current issue.

Data sources: Data sources included MedLine, CINAHL, EMBASE, Pubmed, and Google Scholar. Sources were chosen to answer the Population, Intervention, Comparison, and Outcome (PICO) question: In the surgical patient undergoing spinal anesthesia (S), how does the use of dexmedetomidine as an anesthetic adjunct (I), compared to its non-use (C), affect the postoperative (or perioperative) consumption of opioids (O)?”

Study selection: The inclusion criteria for the articles included: Studies published after 2019, RCTs, published in English, dexmedetomidine as the treatment, and opioid consumption as the primary outcome. Exclusion criteria included: meta-analyses and systematic analysis, failure to focus on opioid consumption as the primary outcome, and dexmedetomidine not used as treatment.

Results: The evidence search and screening resulted in 7 RCTs. Three studies demonstrated dexmedetomidine infused at the induction of anesthesia to reduce post-operative and perioperative opioid consumption. Four studies demonstrated dexmedetomidine to reduce cumulative opioid consumption when administered before induction of anesthesia. One study demonstrated intranasal dexmedetomidine to impact cumulative opioid consumption.

Conclusion: Evidence shows that dexmedetomidine as adjunct therapy reduces opioid consumption preoperatively and post-operatively. The least effective dose is 0.5 μg/kg-1 μg/kg, and can be infused before or at the induction of anesthesia.

Keywords: Dexmedetomidine, opioids, spinal anesthesia, opioids consumption, surgical units, surgery, postoperative, perioperative.



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