Does Dexmedetomidine Affect Opioid Consumption Following Orthognathic Surgery?

Abstract

Background: Despite its purported analgesic effects, controversy exists regarding dexmedetomidine's efficacy as an opioid-sparing anesthetic adjunct.

Purpose: The purpose of this study is to measure the association between dexmedetomidine (DEX) administration during orthognathic surgery and postoperative opioid consumption.

Study design, sample, and setting: A single-blind randomized prospective cohort study was implemented. Patients consenting for orthognathic surgery at Thomas Jefferson University from January 2022 to October 2024 were screened. American Society of Anesthesiologists physical status I to III individuals aged ≥14 years were included. Exclusion criteria were revision surgery, recreational drug use, opioid prescription within 2 years, and chronic pain.

Predictor variable: The predictor variable was anesthetic adjunct. Subjects were randomized to receive DEX or no DEX (control).

Main outcome variables: The primary outcome variable was 24-hour postoperative opioid consumption, which was calculated as morphine milligram equivalents (MME). Postoperative pain was assessed using a visual analog scale (VAS) at 6 hours and upon patient-controlled analgesia (PCA) discontinuation at 7:00 am the following day (VASPCA). The ratio of PCA that attempts to bolus deliveries was calculated.

Covariates: Covariates included age, sex, body mass index (BMI), and operative duration.

Analyses: Descriptive statistics were calculated. Shapiro-Wilk test was used to assess sample normality. Relationships between continuous variables and DEX were studied using t test or Wilcoxon rank-sum test; χ² test was used for the categorical covariate. Significance was P < .05.

Results: Of 66 enrollees, 50 (75.8%) subjects completed the trial (25 DEX, 25 no DEX). The mean (SD) ages for the no DEX and DEX group cohorts were 35.9 (13.5) and 41.3 (13.6), respectively (P = .2). There were no statistically significant differences in the distribution of covariates between the 2 study groups. Median (interquartile range (IQR)) morphine milligram equivalents consumption was 16.4 (15.4) and 14.8 (12.4) for no DEX and DEX groups, respectively (P = .9). No difference in pain scores was observed at 6 hours (P = .1). Median (interquartile range) VASPCA scores were 5(1) and 4(2) for no DEX and DEX cohorts, respectively (P < .01). Median ratios of PCA that attempts to boluses administered (1.23) were identical between cohorts (P = .9).

Conclusions and relevance: The findings suggest that opioid consumption following orthognathic surgery was not associated with dexmedetomidine administration.