Dexmedetomidine pharmacodynamics: Part II - Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers

Luis I. Cortinez, Yung Wei Hsu, Sam T. Sum-Ping, Christopher Young, John C. Keifer, David MacLeod, Kerri M. Robertson, David R. Wright, Eugene W. Moretti, Jacques Somma

Research output: Contribution to journalArticle

85 Scopus citations

Abstract

Background: Dexmedetomidine is a highly selective α 2- adrenoceptor agonist used for short-term sedation of mechanically ventilated patients. The analgesic profile of dexmedetomidine has not been fully characterized in humans. Methods: This study was designed to compare the analgesic responses of six healthy male volunteers during stepwise target-controlled infusions of remifentanil and dexmedetomidine. A computer-controlled thermode was used to deliver painful heat stimuli to the volar side of the forearms of the subjects. Six sequential 5-s stimuli (ranging 41° to 50°C) were delivered in random order. The recorded visual analog scale was used to fit an Emax model. Results: Compared to baseline, remifentanil infusions resulted in a right shift of the sigmoid curve (increased T 50, the temperature producing a visual analog scale score of 50% of the maximal effect, from 46.1°C at baseline to 48.4° and 49.1°C during remifentanil infusions) without a change of the steepness of the curve (identical Hill coefficients γ during baseline and remifentanil). Compared to baseline, dexmedetomidine infusions resulted in both a right shift of the sigmoid curve (increased T 50 to 47.2°C) and a decrease in the steepness of the curve (decreased γ from 3.24 during baseline and remifentanil infusions to 2.45 during dexmedetomidine infusions). There was no difference in the pain responses between baseline and after recovery from remifentanil infusions (identical T 50 and γ). Conclusion: As expected, dexmedetomidine is not as effective an analgesic as the opioid remifentanil. The difference in the quality of the analgesia with remifentanil may be a reflection of a different mechanism of action or a consequence of the sedative effect of dexmedetomidine.

Original languageEnglish (US)
Pages (from-to)1077-1083
Number of pages7
JournalAnesthesiology
Volume101
Issue number5
DOIs
StatePublished - Nov 1 2004

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Cortinez, L. I., Hsu, Y. W., Sum-Ping, S. T., Young, C., Keifer, J. C., MacLeod, D., Robertson, K. M., Wright, D. R., Moretti, E. W., & Somma, J. (2004). Dexmedetomidine pharmacodynamics: Part II - Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology, 101(5), 1077-1083. https://doi.org/10.1097/00000542-200411000-00006