Anti-nociceptive Effects of Dexmedetomidine Infusion Plus Modified Intercostal Nerve Block During Single-port Thoracoscopic Lobectomy: A Double-blind, Randomized Controlled Trial

Abstract

BACKGROUND: Multimodal general anesthesia based on modified intercostal nerve block (MINB) has been found as a novel method to achieve an intraoperative opioid-sparing effect. However, there is little information about the effective method to inhibit visceral nociceptive stress during single-port thoracoscopic surgery. OBJECTIVE: To investigate whether a low-dose dexmedetomidine infusion followed by MINB might be an alternative method to blunt visceral stress effectively. STUDY DESIGN: Double-blind, randomized control trial. SETTING: Affiliated hospital from March 2020 through September 2020. METHODS: Fifty-four patients were randomized (1:1), 45 patients were included to receive dexmedetomidine with a 0.4 microgram/kg bolus followed by 0.4 microgram/kg/h infusion (group Dex) or saline placebo (group Con). During the operation, an additional dose of remifentanil 0.05–0.25 microgram/kg/min was used to keep mean arterial pressure (MAP) or heart rate (HR) values around 20% below baseline values. The primary outcome was to evaluate remifentanil consumption. Secondary outcomes included intraoperative hemodynamics, the first time to press an analgesia pump, and adverse effects. RESULTS: Remifentanil consumption during surgery was markedly decreased in the Dex group than in the Con group (0 [0-0] versus 560.0 [337.5-965.0] microgram; P = 0.00). MAP and HR in the Con group during the first 5 minutes after visceral exploration was significantly higher than in the Dex group (P < 0.05). Time to first opioid demand was significantly prolonged (P = 0.04) and postoperative length of stay was shortened slightly in the Dex group (P = 0.05). LIMITATIONS: This study was limited by the measurement of nociception. CONCLUSIONS: This study demonstrates that low-dose dexmedetomidine infusion combined with MINB might be an effective alternative method to blunt visceral stress in patients undergoing single-port thoracoscopic lobectomy. Furthermore, the analgesic effect of MINB was significantly prolonged after dexmedetomidine infusion. KEY WORDS: Opioid-sparing, nociceptive stress, dexmedetomidine, remifentanil

A Novel Opioid-Sparing Analgesia Following Thoracoscopic Surgery: A Non-Inferiority Trial

“… 16 , 17 Thus, a clinical trial demonstrated that DEX ameliorated visceral pain after abdominal surgery in patients via a dose-dependent inhibitory on C-fibers and Aα-fibers. 18 Also, our preliminary study 3 showed an intra-operative opioid-sparing effect extending 48 h after surgery after MINB and intra-operative DEX infusion might be an alternative method to blunt visceral stress effectively in patients undergoing thoracoscopic lobectomy. This current study focused on the postoperative opioid-sparing effect and further demonstrated the feasibility of postoperative opioid-free analgesia.…”

“…Near the incision site where a chest drainage tube was inserted, the ultrasound transducer (S-Nerve; SonoSite Iberica S.L., Madrid, Spain) was placed perpendicular to the long axis of the upper rib (posterior axillary line level). As the previous protocol by our study, 3 the 21G needle was inserted which targeted the lateral border of the upper rib in a caudal-to-cephalic direction along the long axis of the transducer. Then 5 mL of 0.35% ropivacaine combined with 0.025% dexamethasone was injected when the needle reached this special landmark, which facilitated the drug’s diffusion up, down, and back, between the anterior serratus muscle and the coastal space ( S. Figure 1 ).…”

“… 2 However, little is known about its potentially facilitating enhanced recovery effect. Recently, our preliminary observation found that multimodal analgesia based on modified intercostal nerve block (MINB) 3 was a novel method to achieve an opioid-sparing effect perioperatively in a minimally invasive lobectomy. It would be interesting to investigate whether multimodal strategies based on MINB could potentially facilitate enhanced recovery.…”