Effect of perioperative intravenous infusion of dexmedetomidine on the quality of early and long-term postoperative recovery in patients undergoing thoracoscopic surgery: a randomized controlled trial.

Background: This study aimed to evaluate the effect of perioperative intravenous infusion of dexmedetomidine on the quality of early and long-term postoperative recovery in patients undergoing thoracoscopic surgery, and to further analyze its potential mechanism.

Methods: A total of 80 patients were enrolled and randomized to dexmedetomidine group, which received perioperative intravenous infusion of dexmedetomidine and normal saline group, which received equivalent doses of normal saline. The primary outcome was total QoR-15 score on postoperative day 1. Secondary outcomes included total QoR-15 Score on postoperative day 2, day 3, day 7, month 1 and month 3 and the score of dimensions of QoR-15, NRS Score, incidence of moderate to severe pain, physical comfort score, hospital anxiety and depression scale score and adverse reactions on postoperative day 1, day 2, day 3, day 7, month 1 and month 3.

Results: The total QoR-15 score of dexmedetomidine group on postoperative day 1 was significantly higher than that of saline group (127.1±7.3 vs. 118.4±9.3, P<0.001), the same as on postoperative day 2, day 3, day 7 and month 1 (all P<0.001). Further analysis of each dimension showed that the enhancement of total QoR-15 score on postoperative day 1, day 2, day 3 in dexmedetomidine group was mainly due to the improvement of pain and physical comfort (all P<0.0.05), which was consistent with NRS score, incidence of moderate to severe pain and physical comfort score (P<0.0.05). The increase of total QoR-15 score on day 7 was mainly due to the combined effect of pain, physical comfort, and emotional dimensions (all P<0.05). The enhancement of total QoR-15 score on postoperative month 1 was mainly due to an improvement in the emotional dimension, which was consistent with hospital anxiety and depression scale score (all P<0.05). In terms of adverse reactions, the incidence of nausea and vomiting on postoperative day 1 and day 2 was significantly reduced in the dexmedetomidine group (48.7% vs. 25.6%, 38.5% vs. 17.9%, both P<0.05), and there was no significance in other aspects (all P<0.05).

Conclusions: Perioperative intravenous infusion of dexmedetomidine significantly improved the quality of recovery after thoracoscopic surgery without increasing the occurrence of adverse reactions, and the early enhancement may be mainly through the improvement of pain and physical comfort, the long-term enhancement may be mainly through the improvement of emotional state.