Efficacy of adding dexmedetomidine as adjuvant with bupivacaine in ultrasound-guided erector spinae plane block for post thoracotomy pain: Randomized controlled study

Abstract

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.

The role of dexmedetomidine as an adjuvant for high-thoracic erector spinae plane block for analgesia in shoulder arthroscopy; a randomized controlled study

“…This is similar to another randomized controlled trial done by Elshal et al, [ 19 ] who documented that the addition of dexmedetomidine 0.5 µg/kg to bupivacaine in US-guided ESPB enhanced analgesia in open thoracotomy; this was evidenced by extended analgesic duration and a lower Visual Analog Scale at rest and while coughing and both intraoperative fentanyl and postoperative morphine use in 24 h with comparable hemodynamic characteristics in both groups. Dexmedetomidine's analgesic effects are regulated by various processes [ 20 ].…”

The effect and safety of dexmedetomidine as an adjuvant to local anesthetics in erector spinae plane block: a systematic review and meta-analysis of randomized controlled trials

“…The details of the included RCTs are summarized in Table 1 . Of the 8 studies, 7 studies were from China [ 19 , 21 – 26 ], 1 studies were from Egypt [ 20 ]. The level of nerve block localization was T 5 in 5 trials [ 19 – 21 , 23 , 26 ], T 4 + T 6 in 1 trial [ 22 ], T 3 in 1 trial [ 24 ], L 3 in 1 trial [ 25 ].…”

“…With the exception of 1 trial that used bupivacaine [ 20 ], 7 trials used another long-acting LAs ropivacaine [ 19 , 21 – 26 ]. The DEX dosage was used in combination with LAs was 0.5 μg/kg in 3 studies [ 20 , 22 , 26 ], and 1 μg/kg in 5 studies [ 19 , 21 , 23 – 25 ]. The types of surgery are open thoracotomy [ 20 , 26 ], video-assisted thoracoscopic lobectomy [ 19 , 21 – 23 ], modified radical mastectomy [ 24 ], and posterior lumbar spine surgery [ 25 ].…”

“…The types of surgery are open thoracotomy [ 20 , 26 ], video-assisted thoracoscopic lobectomy [ 19 , 21 – 23 ], modified radical mastectomy [ 24 ], and posterior lumbar spine surgery [ 25 ].…”

“…Subgroup analyses were performed according to the dosage of DEX because the heterogeneity was high. Both the 0.5 μg/kg [ 20 , 22 ] (MD = 4.86 h; 95% CI = 3.68 to 6.04; p < 0.00001; I 2 = 0%; Fig. 3 ) and 1 μg/kg [ 19 , 21 , 23 ] (MD = 11.00 h; 95% CI = 9.37 to 12.63; p < 0.00001; I 2 = 0%; Fig.…”