Effects of Perioperative Intranasal Dexmedetomidine Spray on Clinical Outcomes of Pulsed Radiofrequency in Patients with Zoster-Associated Pain: A Randomized Controlled Trial

Abstract

Objective To investigate the effects of perioperative intranasal dexmedetomidine spray on hemodynamic stability, postoperative analgesia and sleep quality in patients with zoster-associated pain (ZAP) undergoing pulsed radiofrequency (PRF), and assess its clinical efficacy and safety. Methods A single-center, randomized, double-blind, parallel-controlled trial was conducted. Sixty-eight ZAP patients receiving dorsal root ganglion PRF were randomly assigned (1:1) to the dexmedetomidine (Dex) group or control group. The Dex group received intranasal dexmedetomidine 40 μg 30 min preoperatively, followed by 40 μg twice daily for 3 postoperative days; the control group received equal-volume normal saline at matched time points. Perioperative mean arterial pressure (MAP) and heart rate (HR) were recorded. Pain intensity (VAS) and sleep quality (PSQI) were assessed at baseline and on postoperative days 1, 3, 7 and 14. The primary outcome was change in MAP from baseline to PRF treatment stage. Linear mixed-effects models were used for longitudinal analyses. Results Baseline characteristics were comparable between groups (all P>0.05). The Dex group showed significantly smaller MAP and HR fluctuations during puncture, nerve stimulation and PRF treatment (group × time interaction, all P<0.001). VAS and PSQI scores were markedly lower in the Dex group at all postoperative time points (all P<0.001 after Bonferroni correction). No severe adverse events occurred; mild-to-moderate transient bradycardia and hypotension in the Dex group required no specific intervention. Conclusion Perioperative intranasal dexmedetomidine spray effectively stabilizes perioperative hemodynamics, improves postoperative analgesia and sleep quality in ZAP patients undergoing PRF, with no serious safety signals observed in this study population. It provides evidence for optimized perioperative management strategies in this population. Trial Registration Chinese Clinical Trial Registry, ChiCTR2500098608, first posted 11/03/2025.