Use of dexmedetomidine for postoperative analgesia in spine patients.

AIM: Postoperative spinal patients remain a challenge for provision of postoperative analgesia. They often exhibit tolerance to narcotics, which requires alternative agents. Our institution has an experience with the use of dexmedetomidine for postoperative analgesia in spine patients. METHODS: This was conducted as a retrospective chart review of spine patients that received dexmedetomidine during an entire calendar year, and we excluded any patients that were mechanically ventilated or received other sedation agents. RESULTS: Twenty-nine patients were identified that received the dexmedetomidine for a mean of 31.3 hours, at a mean rate of 0.5 mcg/kg/hour. Their mean pain score went from 7.1 to 1.6 (P<0.001) within 4 hours of starting the drug. Both the heart rate, and systolic blood pressure decreased by approximately 10% after starting the dexmedetomidine. In 4 patients (13.8%) the dexmedetomidine had to be stopped early on due to bradycardia or hypotension. CONCLUSION: Dexmedetomidine represents an important agent for the treatment of severe postoperative spinal pain as a supplemental agent with patients that do not achieve adequate analgesia from narcotics.

Radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections.

This study was designed to investigate radiation exposure to a physician performing fluoroscopically guided caudal epidural steroid injections. The prospective study design included 100 consecutive fluoroscopically guided caudal epidural steroid injections performed on patients with radiculitis from either herniated nucleus pulposus or lumbar spinal stenosis. Radiation exposure was monitored with the assistance of a radiological technologist (RT) who allocated four dosimetry badges to all physicians performing fluoroscopically guided caudal epidural steroid injections on consecutive patients being treated for radicular pain. The badges were placed on the ring finger, glasses and both the inside and outside of the lead apron worn by the physician. In addition, the RTs also wore a marked badge outside his/her lead apron. A control badge was placed 67 inches away from the fluoroscopy table, and a second control badge was located in a desk over 500 feet away from the procedure, to monitor ambient radiation. The average fluoroscopy time per procedure was 12.55 seconds. The average/cumulative exposure per procedure was 4.10/410 mREM at the "ring" badge, 2.47/247 mREM at the "glasses" badge, 3.98 /398 mREM at the "outside apron" badge and 0.15/15 mREM at the "inside" apron; no radiation was detectable at the "outside room" control badge. The RT's average exposure during these procedures was below the limit of detectability. Radiation exposure to the physician needs to be considered and minimized in the performance of spinal interventional procedures. Our study demonstrates that radiation exposure to the physician performing fluoroscopically guided caudal epidural steroid injections is well within safety limits when he/she adheres to proper technique.