Effect of dexmedetomidine (precedex) administration during awake craniotomy on postoperative inflammatory markers and stress hormones in patients with chronic subdural hemorrhage: A randomized controlled study.

BACKGROUND

Chronic subdural hemorrhage (CSDH) is common in older adults and often requires surgical treatment. This trial assessed whether dexmedetomidine, an α2-adrenergic agonist with minimal respiratory compromise, during awake craniotomy alters postoperative inflammatory and neuroendocrine markers in patients with CSDH.

METHODS

In this single-center randomized trial, 62 patients were allocated to awake craniotomy with dexmedetomidine (Group A, n = 31) or craniotomy under general anesthesia (Group B, n = 31). Serum IL-6, IL-8, CRP, cortisol, and noradrenaline were measured postoperatively. Secondary outcomes were arousal time, VAS pain scores, time to first rescue analgesia, and hospital stay. Analyses were performed in R 4.5.2.

RESULTS

Group A had lower VAS scores at 24 h (mean difference [MD]=-2.13, 95%CI: -2.59 to -1.67; p < 0.001) and 48 h (MD=-2.19, 95%CI: -2.65 to -1.73; p < 0.001), longer time to first rescue analgesia (MD=63.11 min, 95%CI: 56.58-69.65; p < 0.001), and shorter hospital stay (MD=-1.87 days, 95%CI: -2.45 to -1.29; p < 0.001); arousal time did not differ (MD=-0.16 min; p = 0.951). For biomarkers, group-by-time interactions were significant (all p < 0.001). CRP was similar at baseline (ratio=0.98; p = 0.586) but higher at 24 h in Group A (ratio=1.26; p < 0.001). IL-6 and IL-8 were higher early in Group A but lower by 48 h (IL-6 ratio=0.85; IL-8 ratio=0.69; both p < 0.001). Cortisol and noradrenaline were higher in Group A at all time points (all p < 0.001).

CONCLUSION

Dexmedetomidine-assisted awake craniotomy for CSDH was associated with less postoperative pain, delayed rescue analgesia, and shorter hospitalization. Inflammatory markers showed differing trajectories, with lower IL-6 and IL-8 by 48 h, while cortisol and noradrenaline remained higher throughout follow-up.

TRIAL REGISTRATION: PACTR202408593043200 at Pan African Clinical Trials Registry Platform, 21/08/2024.