Assessing the Effect of Intrathecal Dexmedetomidine on Cerebrospinal Fluid Levels of Apoptotic Factors: A Clinical Trial Study in Lumbar Disc Surgery

Background: Dexmedetomidine protective effects on apoptosis in the brain and peripheral organs have been reported in vivo and in vitro. Apoptotic factors of cerebrospinal fluid (CSF) may influence the prognosis of patients undergoing open discectomy surgery. Objectives: This study evaluated the effect of intrathecal dexmedetomidine administration on the CSF levels of apoptotic factors and clinical outcomes in patients undergoing lumbar discectomy. Methods: This clinical trial was conducted on patients undergoing open lumbar discectomy. Forty patients were randomly divided into control and dexmedetomidine groups. In the dexmedetomidine group, 0.1 μg/kg of dexmedetomidine was intrathecally injected after anesthesia induction. Patients’ hemodynamic status during surgery was recorded; additionally, their pain scores were recorded by the Numeric Rating Scale (NRS) in the recovery room. The levels of apoptotic factors including Bax/Bcl-2 and caspase-3 in the CSF were measured at the beginning and end of discectomy, and the results were compared between the two groups. Results: Of the 40 evaluated patients, the mean levels of caspase-3 in the intervention and control groups were 2.28 ± 0.35 and 2.34 ± 0.32 ng/mL before surgery and 2.56 ± 0.42 and 2.72 ± 0.39 ng/mL after surgery, respectively. The levels of Bax/Bcl-2 in the intervention and control groups were 1.01 ± 0.11 and 0.89 ± 0.07 before surgery and 1.28 ± 0.14 and 1.16 ± 0.19 after surgery, respectively. The levels of these two factors were not significantly different. However, the NRS scores were significantly lower in the dexmedetomidine group than in the control group. Conclusions: Intrathecal dexmedetomidine could significantly and safely reduce the NRS score in the intervention group but did not have any significant effect on the CSF levels of apoptotic factors before and after lumbar discectomy surgery.