Dexmedetomidine leads to quicker GI recovery after laparoscopic hysteromyomectomy

In patients undergoing laparoscopic hysteromyomectomy, intraoperative intravenous use of dexmedetomidine may help ease postoperative ileus, hastening the recovery of gastrointestinal (GI) function after operation, according to a recent study.

In the study sample of 106 patients, 54 were given dexmedetomidine who experienced their first flatus a mean of 25.83 hours after the procedure. In comparison, the 52 patients randomized to saline placebo took an average of 27.67 hours before the first postoperative flatus. The between-group difference of 1.84 hours was statistically significant (p=0.019). [Sci Rep 2022;12:14640]

“In patients undergoing laparoscopic hysteromyomectomy, intraoperative intravenous administration of dexmedetomidine significantly reduced the time to first flatus,” the researchers said. “Dexmedetomidine may be considered for improving the postoperative recovery of intestinal function in patients undergoing laparoscopic hysteromyomectomy.”

Dexmedetomidine also proved to be better than placebo at secondary GI recovery outcomes. Time to first feeding, for instance, was significantly shorter in those given dexmedetomidine vs saline (mean, 27.29 vs 28.92 hours; p=0.044), as was the time to first faeces (59.82 vs 63.89 hours; p=0.025).

Abdominal distension was likewise rarer in the dexmedetomidine group, arising in 22.2 percent (n=12) of this group, as opposed to 40.4 percent (n=21) of placebo comparators (p=0.025).

Meanwhile, postoperative nausea, both at 24 hours (18.5 percent vs 36.5 percent; p=0.037) and 48 hours (14.3 percent vs 30.8 percent; p=0.05), was likewise less common among dexmedetomidine recipients.

Perioperative stress response

Postoperative pain, measured using the numeric rating scale, was also better in the dexmedetomidine group at 6 hours (mean, 3.15 vs 3.46) and 12 hours (mean, 3.11 vs 3.38; p<0.05 for both) after the procedure. Concomitantly, its tolerability profile was generally on a par with placebo and introduced no alarming safety signals.

For instance, severe hypoxaemia occurred in 0.02 percent of both treatment arms. Rates of hypotension (11.1 percent vs 11.5 percent) and hypertension (14.8 percent vs 19.2 percent) requiring treatment were also comparable between groups. Bradycardia, in contrast, was significantly more common in the dexmedetomidine group (24.1 percent vs 9.5 percent; p=0.047).

There were reported cases of postoperative stroke, heart failure, or myocardial infarction.

Dexmedetomidine is a highly selective α 2-adrenergic receptor agonist that binds its target to suppress sympathetic activation. The agent can abate the secretion of neurotransmitters from sympathetic ganglion fibres, leading to an overall reduction in the levels of inflammatory factors, which in turn protect organs from oxidative stress and reperfusion injuries. [Hypertension 2013;61:388-394; J Healthc Eng 2021;7161901]

“In general, dexmedetomidine reduces perioperative stress response, benefits anti-inflammatory status, regulates the intestinal immune system, and increases the discharge frequency of the parasympathetic nerve, which leads to the reduction in the incidence of postoperative ileus,” the researchers explained.

Findings of the present study support dexmedetomidine’s mechanism of action as a safe and effective pathway to improve postoperative recovery after laparoscopic hysteromyomectomy. However, important limitations must be considered.

In particular, the present study was a single-centre analysis, which may impact the findings’ generalizability. The researchers also failed to account for the exact serum levels of dexmedetomidine after treatment, which likely plays an important role in the drug’s efficacy.

“The mechanism of action of dexmedetomidine may be related to its blood concentration, therefore, further studies are needed to explore the relationship between the dose of dexmedetomidine and GI function,” the researchers said.