Dexmedetomidine versus Subanaesthetic Ketamine for Opioid-sparing Anaesthesia During Lumbar Spine Surgery Under a Standardised Surgical Pleth Index-guided Analgesic Protocol: A Randomised Controlled Trial.
- 1Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of Anaesthesiology and Critical Care, Puducherry, India.
Abstract
Objective
Lumbar spine surgery is associated with significant perioperative pain and increased opioid requirements. Objective nociception-guided opioid administration using the surgical pleth index (SPI) may facilitate individualised intraoperative analgesic titration. Dexmedetomidine and subanaesthetic ketamine are commonly used opioid-sparing adjuvants; however, their effects under SPI-guided analgesia remain inadequately studied.Methods
In this prospective randomised controlled trial, 50 adult patients undergoing lumbar spine surgery were allocated to 3 groups: dexmedetomidine (Group D), ketamine (Group K), and saline control (Group S). After prone positioning, Group D received a 0.5 μg kg⁻¹ dexmedetomidine bolus followed by a 0.2 μg kg⁻¹ h infusion; Group K received a 0.5 mg kg⁻¹ ketamine bolus followed by a 0.2 mg kg⁻¹ h⁻¹ infusion; and Group S received saline. Intraoperative fentanyl (0.5 μg kg⁻¹) was administered when SPI exceeded 50, as indicated by Adequacy of Anaesthesia monitoring, allowing objective nociception-guided opioid titration. The primary outcome was intraoperative supplemental fentanyl consumption. Secondary outcomes included extubation time, postoperative pain scores, 24-hour fentanyl consumption, and Quality of Recovery (QoR-15) scores.Results
Cumulative intraoperative supplemental fentanyl consumption differed among the groups (P < 0.001), with lower requirements in Groups D (150±45.9 μg) and K (161.7±35.4 μg) than in Group S (220.5±42.6 μg). In contrast, no difference was observed between Groups D and K. Twenty-four-hour postoperative fentanyl consumption also differed significantly among the groups (P < 0.001), with lower consumption in Group D than in Group S, and intermediate consumption in Group K. Extubation time was comparable among the groups. Dexmedetomidine resulted in lower postoperative visual analogue scale scores than saline at all time points; scores also differed between dexmedetomidine and ketamine at 1 hour and between ketamine and saline at 12 hours. QoR-15 scores differed significantly among the groups, with both active treatment groups showing improved recovery compared with the saline group.Conclusion
Within a standardised SPI-guided analgesic protocol, both dexmedetomidine and subanaesthetic ketamine reduced intraoperative opioid requirements without prolonging extubation time compared with saline during lumbar spine surgery. Dexmedetomidine was associated with lower postoperative opioid consumption and improved postoperative recovery compared with saline. Both interventions demonstrated comparable intraoperative opioid-sparing efficacy.
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BibTeX
@article{arivuselvan2026dexmedetomidine,
title = {{Dexmedetomidine versus Subanaesthetic Ketamine for Opioid-sparing Anaesthesia During Lumbar Spine Surgery Under a Standardised Surgical Pleth Index-guided Analgesic Protocol: A Randomised Controlled Trial.}},
author = {Gowthaman Arivuselvan and Srinivasan Swaminathan and Rajasekar Ramadurai and Prasanna Udupi Bidkar},
journal = {Turkish journal of anaesthesiology and reanimation},
year = {2026},
month = oct,
doi = {10.4274/tjar.2026.262419},
url = {https://europepmc.org/article/MED/42969335},
note = {CC BY},
}
RIS
TY - JOUR
TI - Dexmedetomidine versus Subanaesthetic Ketamine for Opioid-sparing Anaesthesia During Lumbar Spine Surgery Under a Standardised Surgical Pleth Index-guided Analgesic Protocol: A Randomised Controlled Trial.
AU - Gowthaman Arivuselvan
AU - Srinivasan Swaminathan
AU - Rajasekar Ramadurai
AU - Prasanna Udupi Bidkar
PY - 2026
DA - 2026/10/01
JO - Turkish journal of anaesthesiology and reanimation
DO - 10.4274/tjar.2026.262419
UR - https://europepmc.org/article/MED/42969335
AB - Objective Lumbar spine surgery is associated with significant perioperative pain and increased opioid requirements. Objective nociception-guided opioid administration using the surgical pleth index (SPI) may facilitate individualised intraoperative analgesic titration. Dexmedetomidine and subanaesthetic ketamine are commonly used opioid-sparing adjuvants; however, their effects under SPI-guided analgesia remain inadequately studied.Methods In this prospective randomised controlled trial, 50 adult patients undergoing lumbar spine surgery were allocated to 3 groups: dexmedetomidine (Group D), ketamine (Group K), and saline control (Group S). After prone positioning, Group D received a 0.5 μg kg⁻¹ dexmedetomidine bolus followed by a 0.2 μg kg⁻¹ h infusion; Group K received a 0.5 mg kg⁻¹ ketamine bolus followed by a 0.2 mg kg⁻¹ h⁻¹ infusion; and Group S received saline. Intraoperative fentanyl (0.5 μg kg⁻¹) was administered when SPI exceeded 50, as indicated by Adequacy of Anaesthesia monitoring, allowing objective nociception-guided opioid titration. The primary outcome was intraoperative supplemental fentanyl consumption. Secondary outcomes included extubation time, postoperative pain scores, 24-hour fentanyl consumption, and Quality of Recovery (QoR-15) scores.Results Cumulative intraoperative supplemental fentanyl consumption differed among the groups (P < 0.001), with lower requirements in Groups D (150±45.9 μg) and K (161.7±35.4 μg) than in Group S (220.5±42.6 μg). In contrast, no difference was observed between Groups D and K. Twenty-four-hour postoperative fentanyl consumption also differed significantly among the groups (P < 0.001), with lower consumption in Group D than in Group S, and intermediate consumption in Group K. Extubation time was comparable among the groups. Dexmedetomidine resulted in lower postoperative visual analogue scale scores than saline at all time points; scores also differed between dexmedetomidine and ketamine at 1 hour and between ketamine and saline at 12 hours. QoR-15 scores differed significantly among the groups, with both active treatment groups showing improved recovery compared with the saline group.Conclusion Within a standardised SPI-guided analgesic protocol, both dexmedetomidine and subanaesthetic ketamine reduced intraoperative opioid requirements without prolonging extubation time compared with saline during lumbar spine surgery. Dexmedetomidine was associated with lower postoperative opioid consumption and improved postoperative recovery compared with saline. Both interventions demonstrated comparable intraoperative opioid-sparing efficacy.
SN - 2667-677X
SN - 2667-6370
ER -