New therapeutic uses for an alpha2 adrenergic receptor agonist – Dexmedetomidine in pain management

• Dexmedetomidine is analgesic and safe for patients with obstructed airways.
• Dexmedetomidine with local anesthetics is a promising new avenue.
• Peripheral, spinal and supraspinal α2A-ARs are responsible for the mechanism.
• Animal studies show that antinociceptive synergism results from co-application.

Dexmedetomidine was initially approved for clinical use as a sedative. Its development in pain management has been limited. Dexmedetomidine has analgesic effects and analgesic-sparing properties, especially for patients with obstructed airways. Mixing dexmedetomidine with local anesthetics is a promising new avenue to enhance local anesthetics’ effectiveness. Peripheral, spinal and supraspinal α2A-ARs are responsible for the analgesic function of dexmedetomidine. Animal studies have shown that antinociceptive synergism results from co-application of dexmedetomidine and opioids or local anesthetics. Dexmedetomidine has potential adverse effects such as hypotension and bradycardia. Therefore, dexmedetomidine is contraindicated for patients suffering from bradycardia or using β-adrenergic antagonists. Clinical trials of dexmedetomidine in chronic pain or hyperalgesia are lack.