As further proof (if needed) of how journal clubs don’t have to be snooze-inducing analysis and boring powerpoint presentations, the latest NWRAG journal club continued with its fine tradition of a pub based setting and beer lubricated discussion. The target paper this month was selected as ‘The effects of intra-operative dexmedetomidine on postoperative pain, side-effects and recovery in colorectal surgery’, found in the Anaesthesia journal at the link below (1):
Dexmedetomidine and Post-Op Pain
What's It About?
What've They Done?
What've They Found?
Is It Any Good?
- Well designed and conducted study
- Statistically significant reduction in AUC pain scores in dexmedetomidine group
- Unclear clinical significance of this reduction
- No evidence of tangible clinical differences of reduced morphine consumption or side effects.
The authors have made a decent effort at exploring this question, but it is perhaps the vagueness of their initial clinical question that has led to some uncertainty in interpreting these results. They rather broadly set out to look for an improvement in post-op pain, rather than a specific change in a measurable value. As such, finding this numerical difference between the groups doesn’t hold a clear meaning for us, and it isn’t explored further by the authors. There are suggestions here about the potential role for alpha-2 agonists as an adjuvant analgesic, but nothing to massively change current practice.
As always please leave your thoughts on this article and on your current clinical experience with dexmedetomidine as an adjuvant analgesic. I must also say a big thanks to NWRAG and fellow journal clubbers Philippa Shorrock, Matt Jackson, Naomi Cochrane, Kunal Lund and Nick Plummer who contributed most of the above. Thanks for reading.
2. Dexmedetomidine Meta-analysis: Pain. 2013