Comparative Study between Dexmedetomidine Versus Dexamethasone as Adjuvants to Levobupivacaine for Cervical Plexus Block in Patients Undergoing Thyroid Operation. Prospective-Randomized Clinical Trial

Abstract

Background: Thyroidectomy is the most common endocrine surgical procedure, and many challenges are encountered during the preoperative, intraoperative, and postoperative periods. After thyroidectomy, bilateral superficial cervical block is the most successful option reducing postoperative pain, analgesic needs and postoperative complications such as vomiting. Objective: Our study aimed to evaluate the analgesic effect, onset time of sensory block, duration time, postoperative visual analogue score (VAS) and complications of adding dexmedetomidine versus dexamethasone to levobupivacaine for cervical plexus block. Patients and Methods: A prospective-randomized clinical trial study that was conducted at Sohag University between April 2018 and March 2020. The study included fifty patients with (ASA) Class I or II, aged 30 to 60 years were scheduled for euthyroid surgeries (including thyroid adenoma, Hashimoto's goiter, and nodosity thyroiditis) Results: The addition of dexmedetomidine to levobupivacaine (group D) shortened the sensory block onset time compared to dexamethasone added to the levobupivacaine group (group S) (p < 0.05). The duration of analgesia of cervical plexus block in group (D) was significantly longer than that in group (S) (232.34 versus 303.55 min; p < 0.05). HR level in group (D) was significantly lower than that in group (S) (p < 0.05). Conclusion:The addition of 1 μg kg−1 dexmedetomidine to levobupivacaine for cervical plexus block (BSCPB) shortened the sensory block onset time and extended the duration of analgesia and increased the quality of analgesia more superior than the addition of dexamethasone.

Post-operative analgesic efficacy of 0.25% ropivacaine with dexmedetomidine versus dexamethasone as an adjuvant in bilateral superficial cervical plexus block for thyroidectomy under general anaesthesia - A comparative randomized clinical study

“…The mean total analgesic dose of tablet or injection of diclofenac, given in the first 24 hours in both groups, was comparable. It has been similarly observed in studies done by Elbahrawy et al , [ 3 ] Banu et al , [ 4 ] Hassan et al , [ 12 ] and Santosh et al . [ 18 ] that the addition of either dexmedetomidine or dexamethasone as an adjunct to the LA in BSCPB results in a reduction of post-operative analgesic requirement.…”

“…A steady decline in all three parameters was observed in the initial part of intraoperative monitoring in both groups A and B, possibly due to the synergistic effect of drugs used for induction of anaesthesia, namely injection midazolam, fentanyl, propofol, and vecuronium. From 30 minutes to 75 minutes of surgery, there was a statistically significant difference in all SBP, DBP, and HR, with vitals being lower in group A than in group B. Aliste et al , [ 11 ] Hassan et al , [ 12 ] and Albrecht et al . [ 13 ] also reported a similar decrease with dexmedetomidine while comparing it with dexamethasone as an adjuvant for various blocks.…”

“…Hassan et al . [ 12 ] in their study compared dexmedetomidine and dexamethasone as adjuvants to levobupivacaine for BSCPB and observed that dexmedetomidine added to levobupivacaine resulted in considerably longer analgesic duration than dexamethasone administered to the levobupivacaine group (232.34 versus 303.55 min; P < 0.05). Similar observations were reported in a study by Singla et al .…”

Dexamethasone versus Dexmedetomidine as Adjuvant to Bupivacaine in Ultrasound Guided Erector Spinae Plane Block for Analgesia in Total Abdominal Hysterectomy

“…Researchers had found that addition of dexmedetomidine (50 µg) to 30 ml ropivacaine 0.5% in ultrasound-guided supraclavicular brachial plexus block resulted in earlier onset of sensory block (19) . Also, it was earlier in Hassan et al study with p value 0.007 between dexmedetomidine and dexamethasone as adjuvants to levobupivacaine for cervical plexus block in patients undergoing thyroid operation (20) .…”