Year 2019 / Volume 26 / Number 1

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Original

Dexmedetomidine versus endovenous lidocaine in breakthrough pain control and functionality in patients with lumbar stenosis

Rev. Soc. Esp. Dolor. 2019; 26(1): 14-20 / DOI: 10.20986/resed.2018.3656/2018

Nayely Teresa Guillén Ramírez, Miguel Jimenez Olvera, Marcos Antonio Morales Aguila, Carlos Omar López López, Arturo Reding-Bernal, Juan Carlos Arista Villanueva, Rafael Orlando Vallejo Estrella, David Javier Amado Magdaleno, Patricia Badillo Rivero


ABSTRACT

Introduction: The pain is a reason for absenteeism labour, especially breakthrough pain secondary to narrow lumbar canal. Dexmedetomidine is an analgesic, act by inhibiting the release of substance P in the nociceptive pathway and blocks the aspartate and glutamate receptors. On the other hand, lidocaine also prevents and relieves pain by interrupting neuroconduction, binding
to its specific receptor within the sodium channels.
Objective: To evaluate the analgesic efficacy of dexmedetomidine versus lidocaine in intravenous perfusion as a treatment for breakthrough pain secondary to narrow lumbar canal.
Material and methods: Controlled clinical trial, randomized, triple-blind, performed at the HGM pain clinic, two groups of patients with diagnosis of breakthrough pain secondary to narrow lumbar canal were evaluated; group one was treated with dexmedetomidine (0.3 mcg/kg) and the other group was treated with lidocaine (2 mg/kg) in intravenous infusion. Measurement of pain intensity and sedation status was made before starting the treatment and after 30, 60 and 120 minutes. The functionality of the patients was also assessed through the Oswestry disability index before and seven days after treatment. Secondarily evaluated the effect of treatments on vital signs.
Results: There was not any statistically signifi cant difference in the reduction of pain intensity at 120 minutes between patients treated with dexmedetomidine (EVA 1.29 ± 1.63) compared with those who were treated with lidocaine (EVA 1 ± 1.19, p = 0.594), it was observed that at the end of drugs perfusion, dexmedetomidine produced greater sedation, unlike lidocaine (p = 0.003), both treatments improved functionality in all patients without having a statistically signifi cant difference between treatments (p = 0.508), they were not observed depressant effects on vital signs.
Conclusions: Dexmedetomidine and lidocaine are just as equally effective for the treatment of breakthrough pain, with onset of action in the fi rst 30 minutes after the infusion started until the next 2 hours, no adverse drug events were observed at the recommended doses.



RESUMEN

Introducción: El dolor es un motivo de ausentismo laboral, en especial el dolor irruptivo secundario a canal lumbar estrecho. La dexmedetomidina como analgésico actúa inhibiendo la liberación de sustancia P en la vía nociceptiva y bloquea los receptores de aspartato y glutamato. Por otro lado, la lidocaína también previene y alivia el dolor mediante la interrupción de la neuroconducción, uniéndose a su receptor específico dentro de los canales de sodio.
Objetivo: Evaluar la efi cacia analgésica de la dexmedetomidina versus lidocaína en perfusión endovenosa como tratamiento del dolor irruptivo secundario a canal lumbar estrecho.
Material y métodos: Ensayo clínico controlado, aleatorizado, triple ciego, realizado en la clínica del dolor del HGM, se evaluaron dos grupos de pacientes con diagnóstico de dolor irruptivo secundario a canal lumbar estrecho; un grupo tratado con dexmedetomidina (0,3 mcg/kg) y otro grupo tratado con lidocaína (2 mg/kg) en perfusión endovenosa. Se realizó medición de la intensidad del dolor y el estado de sedación antes de iniciar el tratamiento y posteriormente a los 30, 60 y 120 minutos. También se evaluó la funcionalidad de los pacientes a través del índice de discapacidad de Oswestry antes y a los siete días del tratamiento. Se evaluó de forma secundaria el efecto de los tratamientos sobre los signos vitales.
Resultados: No hubo diferencia estadísticamente significativa en la reducción de la intensidad del dolor a los 120 minutos entre los pacientes tratados con dexmedetomidina (EVA 1,29 ± 1,63) comparados con los tratados con lidocaína (EVA 1 ± 1,19, p = 0,594). Se observó que al final de la perfusión de los fármacos, la dexmedetomidina produjo mayor sedación a diferencia de la lidocaína (p = 0,003). Ambos tratamientos mejoran la funcionalidad en todos los pacientes sin haber diferencia estadísticamente significativa entre los tratamientos (p = 0,508) no se observaron efectos depresores sobre los signos vitales.
Conclusiones: La dexmedetomidina y la lidocaína son igual de eficaces para el tratamiento del dolor irruptivo, con inicio de acción en los primeros 30 minutos de iniciada la perfusión hasta las siguientes 2 horas. No se observaron eventos adversos medicamentosos a las dosis recomendadas.


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Guillén Ramírez N, Jimenez Olvera M, Morales Aguila M, López López C, Reding-Bernal A, Arista Villanueva J, et all. Dexmedetomidine versus endovenous lidocaine in breakthrough pain control and functionality in patients with lumbar stenosis. Rev Soc Esp Dolor 2019; 26(1): 14-20 / DOI: 1020986/resed20183656/2018


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Publication history

Received: 18/01/2018

Accepted: 06/04/2018

Online First: 04/06/2018

Published: 07/03/2019

Article revision time: 74 days

Article Online First time: 137 days

Article editing time: 413 days


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