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

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.