The effect of dexmedetomidine on emergence agitation and pain in post-anesthesia recovery of patients undergoing upper limb elective orthopedic surgery: a double-blind randomized clinical trial.

Background and objective: Emergence agitation is a common complication following anesthesia, particularly impacting recovery in patients undergoing elective orthopedic surgeries. This study aimed to test the hypothesis that dexmedetomidine would reduce the incidence of emergence agitation and postoperative pain in patients undergoing upper limb orthopedic surgery under general anesthesia.

Methods: This prospective, randomized, double-masked, placebo-controlled clinical trial was conducted at Fatemi Hospital in Ardabil, Iran. Patients scheduled for elective upper limb orthopedic surgeries were randomly assigned to receive either dexmedetomidine (0.4 µg/kg/hr) or a placebo during surgery. The primary outcome was the incidence of emergence agitation, assessed using the Riker Sedation-Agitation Scale. Secondary outcomes included: the severity of emergence agitation, postoperative pain intensity measured with the Visual Analog Scale, hemodynamic parameters, recovery time, and adverse events.

Results: A total of 150 patients were enrolled, with 75 in each group. Regarding the primary outcome, the dexmedetomidine group exhibited a significantly lower incidence of emergence agitation (14.7% vs. 48.0%, p = 0.001). Among secondary outcomes, the dexmedetomidine group reported lower pain scores (Visual Analog Scale: 2.32 ± 1.14 vs. 4.77 ± 0.79, p = 0.001) and showed significant differences in heart rate and systolic blood pressure, with lower values in the dexmedetomidine group (p = 0.022 and p = 0.008, respectively).

Conclusion: The intraoperative infusion of dexmedetomidine significantly reduces the incidence of emergence agitation and is associated with improved postoperative pain management in adults undergoing elective upper limb orthopedic surgery. These findings support the use of dexmedetomidine as a beneficial adjunct in anesthetic practice to enhance recovery outcomes.