Efficacy and safety of intraoperative dexmedetomidine in pediatric posttonsillectomy pain: Peritonsillar versus intravenous administration

Background
Although being used off-label, the utility of dexmedetomidine in pediatric settings is increasing. Alpha-2 agonists have peripheral analgesic effects. This prospective, randomized, double-blind, Placebo-controlled study was designed to evaluate the safety and efficacy of dexmedetomidine single intraoperative preincisional dose in pediatric patients undergoing tonsillectomy and adenoidectomy.
Patients and methods
Eighty-four children (5–12 years) were randomized into three groups: DEX.IV ( = 28) received dexmedetomidine 1 μg/kg iv. infusion in 10 min, DEX.PT ( = 28) received dexmedetomidine 1 μg/kg peritonsillar infiltration, and the Placebo controls ( = 28). Assessment parameters included pain, sedation, hemodynamics, and adverse effects.
Results
Intraoperative dexmedetomidine administration resulted in a significant reduction in pain scores postoperatively in the DEX.IV and DEX.PT groups, with no significant difference between them. The time to first postoperative analgesic request was significantly prolonged in DEX.IV (583.45 ± 157.94 min,  < 0.000) and DEX.PT (537.61 ± 106.17 min,  < 0.000) groups compared with the Placebo group (119.75 ± 43.44 min). Similarly, a significantly lower paracetamol consumption during the first postoperative day was recorded in the DEX.IV (459.37 ± 114.82 mg,  < 0.000) and DEX.PT (475.38 ± 143.11 mg,  < 0.000) groups, than in the Placebo group (705.00 ± 249.27 mg), with no significant difference between DEX.IV and DEX.PT groups. Patients in the DEX.IV group exhibited significantly prolonged extubation times ((13.83 ± 3.38 min,  < 0.000) and significantly higher mean Ramsay sedation scores at 15, 30, 60, 120, and 180 min postoperative ( < 0.000), compared with DEX.PT and Placebo groups. The mean intraoperative heart rates were significantly slower in DEX.IV group during and after the intravenous infusion of dexmedetomidine and at 15th min intraoperative ( < 0.05), compared with DEX.PT and Placebo groups, with no significant differences in mean heart rates among the groups in other time points measured. Patients in DEX.PT group had a significantly higher total oral intake in first day postoperative ( < 0.000) and a significantly higher family satisfaction ( < 0.000), compared with DEX.IV and Placebo groups.
Conclusion
Peritonsillar infiltration or iv. dexmedetomidine similarly enhanced the postoperative analgesia after tonsillectomy in pediatric patients. However, locally applied dexmedetomidine was associated with no systemic effects, higher total oral intake in first day postoperative, and higher family satisfaction.