Dexmedetomidine-based opioid-sparing anesthesia in video-assisted thoracoscopic surgery: a randomized controlled trial
- 1Department of Anesthesiology, Kaohsiung Veterans General Hospital
Abstract
Background Dexmedetomidine has increasingly been incorporated into opioid-sparing anesthetic strategies during video-assisted thoracoscopic surgery (VATS) because of its analgesic properties and minimal respiratory depression. However, dexmedetomidine remains associated with dose-related hemodynamic adverse effects, particularly bradycardia and hypotension. We evaluated whether a reduced-dose dexmedetomidine regimen decreases intraoperative opioid requirements while maintaining acceptable hemodynamic safety during VATS. Methods In this prospective randomized controlled trial, 68 patients undergoing VATS were randomly assigned to either a dexmedetomidine group or a control group (34 patients each). The dexmedetomidine group received a loading dose of 0.5 µg/kg followed by continuous infusion at 0.5 µg/kg/h during surgery. The control group received conventional fentanyl-based anesthesia. The primary outcome was maintenance-phase rescue fentanyl consumption. Secondary outcomes included postoperative pain scores, postoperative nausea and vomiting (PONV), postoperative respiratory complications, and perioperative safety outcomes. Results Maintenance-phase rescue fentanyl consumption was significantly lower in the dexmedetomidine group than in the control group (18.7 vs. 33.2 µg, P = 0.009). Postoperative pain scores, rescue analgesic requirements, PONV, and respiratory complications were comparable between groups. However, the dexmedetomidine group demonstrated a higher incidence of intraoperative bradycardia (23.5% vs. 0%, P = 0.005) and postoperative hypotension during PACU stay (23.5% vs. 2.9%, P = 0.027). These hemodynamic events were transient and responsive to pharmacologic intervention. Conclusions Dexmedetomidine-based opioid-sparing anesthesia reduced maintenance-phase rescue fentanyl administration during VATS. However, the reduction was modest, was not associated with clear postoperative benefits, and was accompanied by increased bradycardia and hypotension. Trial registration ClinicalTrials.gov (NCT05431322), registered on 14 June 2022. Available at https://clinicaltrials.gov/study/NCT05431322 .
Related
- Effects of multiple low-dose intranasal dexmedetomidine administration on postoperative pulmonary complications in elderly patients undergoing thoracoscopic radical resection of lung cancer: a single-center randomized controlled trial
- Closed Versus Open Vent Port Techniques and the Disconnection Technique for Optimizing Lung Collapse With Bronchial Blockers in Video‐Assisted Thoracoscopic Surgery: A Randomized Controlled Trial
- Comparison of dexmedetomidine and droperidol-fentanyl for asleep-awake-asleep techniques in awake craniotomy anesthesia: a randomized controlled study.
- Ciprofol versus propofol for general anesthesia during thoracoscopic surgery: a randomized double-blind trial
- Effect of adding preoperative serratus anterior plane block to intercostal nerve block with liposomal bupivacaine on postoperative pain in patients undergoing video-assisted thoracoscopic lung resection: study protocol for a prospective randomized controlled trial
BibTeX
@article{hsieh2026dexmedetomidinebased,
title = {{Dexmedetomidine-based opioid-sparing anesthesia in video-assisted thoracoscopic surgery: a randomized controlled trial}},
author = {Kai-Wei Hsieh and Chun-Hsien Wen and Chen-Hsiu Chen},
journal = {BMC Anesthesiology},
year = {2026},
month = jul,
doi = {10.1186/s12871-026-04070-w},
url = {https://doi.org/10.1186/s12871-026-04070-w},
note = {CC BY},
}
RIS
TY - JOUR
TI - Dexmedetomidine-based opioid-sparing anesthesia in video-assisted thoracoscopic surgery: a randomized controlled trial
AU - Kai-Wei Hsieh
AU - Chun-Hsien Wen
AU - Chen-Hsiu Chen
PY - 2026
DA - 2026/07/01
JO - BMC Anesthesiology
DO - 10.1186/s12871-026-04070-w
UR - https://doi.org/10.1186/s12871-026-04070-w
AB - Background Dexmedetomidine has increasingly been incorporated into opioid-sparing anesthetic strategies during video-assisted thoracoscopic surgery (VATS) because of its analgesic properties and minimal respiratory depression. However, dexmedetomidine remains associated with dose-related hemodynamic adverse effects, particularly bradycardia and hypotension. We evaluated whether a reduced-dose dexmedetomidine regimen decreases intraoperative opioid requirements while maintaining acceptable hemodynamic safety during VATS. Methods In this prospective randomized controlled trial, 68 patients undergoing VATS were randomly assigned to either a dexmedetomidine group or a control group (34 patients each). The dexmedetomidine group received a loading dose of 0.5 µg/kg followed by continuous infusion at 0.5 µg/kg/h during surgery. The control group received conventional fentanyl-based anesthesia. The primary outcome was maintenance-phase rescue fentanyl consumption. Secondary outcomes included postoperative pain scores, postoperative nausea and vomiting (PONV), postoperative respiratory complications, and perioperative safety outcomes. Results Maintenance-phase rescue fentanyl consumption was significantly lower in the dexmedetomidine group than in the control group (18.7 vs. 33.2 µg, P = 0.009). Postoperative pain scores, rescue analgesic requirements, PONV, and respiratory complications were comparable between groups. However, the dexmedetomidine group demonstrated a higher incidence of intraoperative bradycardia (23.5% vs. 0%, P = 0.005) and postoperative hypotension during PACU stay (23.5% vs. 2.9%, P = 0.027). These hemodynamic events were transient and responsive to pharmacologic intervention. Conclusions Dexmedetomidine-based opioid-sparing anesthesia reduced maintenance-phase rescue fentanyl administration during VATS. However, the reduction was modest, was not associated with clear postoperative benefits, and was accompanied by increased bradycardia and hypotension. Trial registration ClinicalTrials.gov (NCT05431322), registered on 14 June 2022. Available at https://clinicaltrials.gov/study/NCT05431322 .
SN - 1471-2253
ER -