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.

Background & Objective: Erector Spinae Plane block (ESPB) is used in patients subjected to modified radical mastectomy (MRM) as a part of balanced anesthesia technique, and to offer prolonged postoperative analgesia. Local anesthetic agents are usually combined with various adjuvants to augment the effect. We compared dexmedetomidine (Dex) versus dexamethasone as adjuvants to ESPB in patients undergoing MRM. Methodology: This randomized controlled study involved 90 patients subjected to MRM under general anesthesia with preoperative ESPB using 30 ml levobupivacaine 0.25%. They were randomly assigned into three equal groups according to the adjuvants used. Dex Group (n = 30) received 1 µg/kg dexmedetomidine, Dexa Group (n = 30) received 10 mg dexamethasone, and ESPB Group (n = 30) received no adjuvants. Patients were monitored for pain using VAS scores and vital signs. The primary outcome measure was total morphine consumption. The secondary outcomes were intraoperative fentanyl consumption, pain intensity, and analgesia duration. Results: The postoperative analgesia duration was significantly longer in the Dex group compared with the ESPB group (P = 0.029) but not in the dexamethasone group. Intraoperative fentanyl and postoperative morphine consumption were significantly lower in the Dex group than in the ESPB group. VAS scores were significantly lower in the Dex group than in the ESPB group at rest and movement. VAS scores of the Dexamethasone group were similar to that of the ESPB group at rest and movement. Conclusion: As an adjuvant to levobupivacaine in erector spinae plane block, dexmedetomidine reduces pain at rest and with movement, reduces intraoperative fentanyl and postoperative morphine consumption, and prolongs the analgesia duration. It is superior to dexamethasone in pain reduction and duration of analgesia. Key words: Analgesia; Dexamethasone; Dexmedetomidine; Erector Spinae Plane Block; Radical Mastectomy; Postoperative Pain Citation: Ahmed HI, Ali AR, El Emam NH, Magdy M, Gamal RM. Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study. Anaesth. pain intensive care 2022;27(1):65−72. DOI: 10.35975/apic.v27i1.2127 Received: Oct 08, 2022; Reviewed: Nov 10, 2022; Accepted: Nov 22, 2022

The plethysmographic peripheral perfusion index (PPI) is a very useful parameter with various emerging utilities in medical practice. The PPI represents the ratio between pulsatile and non-pulsatile portions in peripheral circulation and is mainly affected by two main determinants: cardiac output and balance between sympathetic and parasympathetic nervous systems. The PPI decreases in cases of sympathetic predominance and/or low cardiac output states; therefore, it is a useful predictor of patient outcomes in critical care units. The PPI could be a surrogate for cardiac output in tests for fluid responsiveness, as an objective measure of pain especially in un-cooperative patients, and as a predictor of successful weaning from mechanical ventilation. The PPI is simple to measure, easy to interpret, and has continuously displayed variables, making it a convenient parameter for detecting the adequacy of blood flow and sympathetic-parasympathetic balance.

Background: Post–thoracotomy pain can result not only in discomfort to the patient but also in pulmonary complications, due to ineffective coughing, which leads to retention of secretions. It can result into chronic post–thoracotomy pain in the long term. Many analgesic techniques are in use to control it, including continuous serratus anterior plane block (SAPB) and thoracic epidural analgesia (TEA). We compared the efficacy and safety of SAPB with continuous TEA in patients undergoing open lung resection. Methodology: This randomized, open–labeled, parallel–controlled trial was done in 60 patients aged 20 to 60 y with American Society of Anesthesiologists physical status II–III, who underwent elective thoracotomy for lung cancer surgery. Patients were randomly allocated according to analgesia either via a thoracic epidural catheter (10 ml levobupivacaine 0.25%, followed by 5 ml/h of 0.125%) or an ultrasound–guided SAPB (30 ml levobupivacaine 0.25% followed by 5 ml/h of 0.125%). Mean arterial pressure and heart rate were recorded during and after the surgery. Inj. fentanyl was used as rescue analgesia. Postoperatively VAS at rest and on coughing was used to assess the pain. Any complications were noted. Results: After excluding five patients, 27 and 28 patients were allocated to the TEA and SAPB groups, respectively. Intraoperatively and until 24 h after the end of surgery, the mean arterial pressure and heart rate were higher in the SAPB group than in the TEA group. Intraoperatively, the requirement for fentanyl was more in the SAPB group. Postoperatively, VAS at rest and cough were significantly higher in the SAPB group. The occurrence of nausea and vomiting, hypotension, and bradycardia were similar in the groups. Conclusions: In patients undergoing open lung resection for cancer, continuous serratus anterior plane block was less effective than thoracic epidural analgesia in controlling postoperative pain and presented similar adverse events. Key words: Serratus anterior plane block; Thoracic epidural, Continuous; Thoracotomy pain, Acute Abbreviations: PTP – Post–thoracotomy pain; TEA – Thoracic epidural analgesia; VAS – Visual analog scale; SAPB – Serratus anterior plane block; MAP – Mean arterial blood pressure; LA – Local anesthetics Preregistration: The study was registered in the institutional board ethical committee (201617026) and on www.clinicaltrials.gov (NCT03933592) Citation: Mostafa MM, Bakeer AH, Gamal RM. Ultrasound–guided serratus anterior plane block versus thoracic epidural analgesia for acute post–thoracotomy pain: a prospective randomized controlled study. Anaesth. pain intensive care 2021;25(6):733–740 ; DOI: 10.35975/apic.v25i6.1692 Received: July 09, 2021, Reviewed: October 06, 2021, Accepted: October 09, 2021