Background: Poor management of postoperative pain results in physiological and psychological side effects with higher morbidity. Erector spinae plane block (ESPB) has shown efficacy in controlling pain in many surgeries. Dexmedetomidine has improved the quality of analgesia in many regional techniques. This study aimed to assess the analgesic outcome of adding dexmedetomidine to bupivacaine in ultrasound (US) guided ESPB for perioperative analgesia for thoracic cancer surgeries. Patients and Methods: In this randomized controlled, double-blind study, 42 patients aged 18-65 years, ASA (American Society of Anesthesiologists) physical status II, scheduled for thoracotomy for cancer surgeries under general anesthesia were included. Patients were allocated into two equal groups: group 1 (ESPB by 28 ml bupivacaine 0.25% + 2 mL saline) and group 2 (ESPB 28 ml bupivacaine 0.25% + 2 mL dexmedetomidine 0.5 µg/kg). Blocks were performed before anesthesia induction. Results: Group 2 consumed lower intraoperative fentanyl and postoperative morphine and had a lower pain score at rest and cough compared to group 1. Group 2 had prolonged time to first request of rescue analgesia compared to group 1. Postoperative nausea and vomiting, and sedation were comparable between both groups. No block-related complications were observed. Conclusions: Adding dexmedetomidine to bupivacaine in US-guided ESPB provided more effective and safe analgesia in thoracotomy.

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Background: Several infants endure substantial pain after hip operations, which can have a negative impact on their health by causing restlessness, depression, and sleep disruption. According to recent research, 20% of infants experience prolonged postsurgical pain 6 to 12 months following major surgery, which is linked to functional impairment and a lower quality of life.Methods: 76 children, ranging from 1 year to 7 years old, scheduled for hip or proximal femur procedures were randomly assigned to receive either unilateral ultrasound guided erector spinae plane (ESPB) with 0.5 mL/Kg of bupivacaine 0.25% or caudal epidural anesthesia (CEA) with 0.5 mL/Kg of bupivacaine 0.25%. The primary outcome was the Face, Legs, Activity, Cry, and Consolability (FLACC) score 2 hours postoperatively. The secondary outcomes were pain scores every 15 minutes for the first hour and then at 6, 12, and 24 hours postoperatively, block failure rate, time taken to perform a successful block, , and the time for first rescue analgesia. Results:The FLACC score 2 hours postoperatively wasn't superior in ESPB group compared to CEA group, in the contrary it was higher in the ESPB group compared to the CEA group at 15, and 30 minutes postoperative (p = 0.005, p = 0.004 respectively). The time to first rescue analgesia was prolonged in the CEA group (p value < 0.001), time to perform successful block was comparable between groups.Conclusions: ESPB hasn't shown a superior analgesic effect to CEA in pediatrics undergoing hip and proximal femur operations.