Dexmedetomidine Combined With Patient-Controlled Analgesia for Palliative Sedation in Terminal-Stage Cancer Patients With Refractory Pain: A Retrospective Analysis of Nine Cases.

Abstract

Background: Cancer-related pain is a pervasive symptom affecting the quality of life in patients with malignant tumors. For those with refractory pain, palliative sedation combined with pain management is recommended. Dexmedetomidine (DEX), known for its unique "awake sedation" effect, remains relatively unexplored when used in conjunction with patient-controlled analgesia (PCA) for terminal-stage cancer patients. This study aimed to assess the safety and efficacy of DEX for palliative sedation with PCA in patients experiencing refractory pain. Methods: A retrospective analysis was conducted on terminal-stage cancer patients who received DEX for palliative sedation combined with PCA in a hospice ward between January 2020 and June 2023. Data collection included general patient information, laboratory tests, rating scales, pain and analgesia conditions, sedation details, palliative sedative effects, and changes in vital signs before and after sedation. Results: Nine patients with terminal-stage cancer received DEX palliative sedation at doses ranging from 0.2 to 1.0 μg/kg·h combined with PCA for refractory pain. After 1 h of sedation and at the maximum sedation dose, the Richmond Agitation-Sedation Scale scores significantly decreased (all p < 0.001). While heart rate, blood oxygen saturation, and respiratory rate remained stable, systolic blood pressure and diastolic blood pressure after 1 h of sedation were significantly lower than presedation levels (p = 0.040 and p = 0.044, respectively). Conclusion: DEX emerges as a promising option for palliative sedation in terminal-stage cancer patients. When used in conjunction with PCA, DEX has been shown to effectively, safely, and stably control refractory pain without inducing adverse effects such as respiratory/circulatory depression.