Intérêt de la Dexmedetomidine intra nasale pour la prévention des douleurs lors de soins infirmiers dans une population adulte hospitalisée et en situation palliative : un essai clinique de supériorité en cross-over, double-aveugle, randomisé contrôlé.

Drug: Opioids;Drug: Dexmedetomidine;Drug: Placebo

Inclusion criteria

- Informed consent signed and dated by the patient or a next of kin;

- =65 years old patients;

- Admitted in the palliative medicine unit;

- Undergoing, minimum once per day, a nursing care procedure lasting between 15 and 30
minutes causing discomfort (anxiety, pain or both) and therefore requiring the
administration of an extra dose of Morphine, Hydromorphone before the nursing care;

- Taking, on a regularly basis, one of the following opioids: Morphine, Hydromorphone,
Buprenorphine, Fentanyl.

Exclusion criteria

- Known hypersensitivity or allergy to Dexmedetomidine or Midazolam;

- Fentanyl extra dose medication before nursing cares;

- Weight > 80Kg;

- Psychomotor agitation;

- Known bronchial aspiration risks : ileus, vomiting, nausea, clinically relevant
gastrooesophageal reflux;

- Known respiratory distress risk: recent need to be ventilated in Intensive Care Unit
setting (<7 days), recent change or degradation of the respiratory status (<2 days)
with apneas or tachypnea (>20/min), or known sleep apnea without non invasive
ventilation; contraindication for nasal drug administration (ex. nasal tumour
obstruction);

- Known cardiac risk : recent cardiac decompensation (<7 days) ; known life threatening
or severe heart rate disorders ; bradycardia <60 bpm or known level II or III
atrioventricular block without pacemaker ; hypotension with systolic blood pressure
less or equal to 100 mmHg; Digoxine treatment;

- Known acute cerebrovascular disease or recent stroke (<1month);

- Already enrolled in another study or previous enrolment into the current study;

- Participation in another study with investigational drug within the 30 days preceding
and during the present study.