Multimodal Analgesic Using Morphine and COX-2 With or Without Dexmedetomidine for Colorectal Surgery
Status:
Completed
Trial end date:
2010-09-01
Target enrollment:
Participant gender:
Summary
Recently, multimodal approach for postoperative pain control has been advocated.Combinations
of traditional and novel pharmacological agents are administered, aiming to improve
analgesia, spare opioid consumption, minimise adverse effects, and improve postoperative
bowel function in colorectal surgery.
One of the novel agents suggested is dexmedetomidine. It is a selective alpha-2 adrenoceptor
agonist, which has been demonstrated to have anaesthetic, sedative and analgesic-sparing
effects. Furthermore, a significant reduction in postoperative morphine consumption by using
patient-controlled analgesia (PCA) has been achieved when dexmedetomidine was administered
before operation. The drug also reduces cate-cholamine secretion, thereby reducing stress and
leading to a modest reduction in heart rate and blood pressure, which may be particularly
beneficial in patients with cardiovascular disease, while respiratory rate is not affected.
In this study, the investigators would like to evaluate the analgesic effects of
dexmedetomidine, which is administered intraoperatively with morphine, followed by
postoperative PCA morphine infusion, for postoperative pain for open and laparoscopic
colorectal surgery. Cyclooxy-genase-2 (COX-2) inhibitors and rescue intramuscular pethidine
will also be incorporated as part of the multimodal analgesia regimens.
Good pain control can help to decrease cardiovascular complications. Emerging data has
suggested a key role of soluble CD40L as inflammatory mediators of atherosclerotic lesion
progression. The investigators would like to evaluate the effect of our analgesic regimens on
soluble CD40L peri-operatively.
The investigators hypothesize that intraoperative dexmedetomidine can reduce postoperative
pain and improve recovery and outcomes.