Opioid-free anesthesia—dexmedetomidine as adjuvant in erector spinae plane block: a case series

Abstract

Background Laparoscopic pain is related to the stretching of the peritoneum and peritoneal irritation caused by insufflation of the parietal peritoneum with carbon dioxide. In 2017, erector spinae plane block (ESPB) was described for management of postoperative pain following open and laparoscopic abdominal surgery. The use of multimodal anesthesia reduces both intraoperative and postoperative opioid use and improves analgesia. The addition of dexmedetomidine to the anesthetic mixture significantly prolongs analgesia, without clinically significant side effects. Case Presentation We describe a series of three Caucasian women cases that illustrate the efficacy of bilateral ESPB performed at the level of the T7 transverse process to provide intraoperative and postoperative analgesia for laparoscopic gynecological surgery. Conclusion Further investigation is recommended to establish the potential for ESPB with dexmedetomidine as adjuvant as an opioid-free anesthetic modality in laparoscopic gynecological surgery.

Dexmedetomidine Added to Ropivacaine for Ultrasound-guided Erector Spinae Plane Block Prolongs Analgesia Duration and Reduces Perioperative Opioid Consumption After Thoracotomy

“… 10 There have been multiple studies claiming increased effectiveness of use of dexmedetomidine and this has been consolidated in a meta-analysis examining the effectiveness of dexmedetomidine as a peripheral nerve block adjuvant. 11 , 12 However, whether interfasical dexmedetomidine prolongs the duration of single-injection ESPB and reduces postoperative opioid consumption after curative-intent open thoracotomy remains uncertain. Therefore, this prospective, randomized, double-blinded, controlled clinical study was performed to investigate whether adding dexmedetomidine to ropivacaine could prolong the duration of single-injection ESPB and reduce postoperative opioid consumption for open thoracotomy.…”

Dexamethasone Plus Bupivacaine Versus Bupivacaine in Bilateral Trans-incisional Paravertebral Block in Lumbar Spine Surgeries, a Randomized Controlled Trial

“…Perineural administration of local anesthetic adjuvants, such as dexamethasone, fentanyl, dexmedetomidine, clonidine, and epinephrine, has been used to extend the duration of analgesia after PNB. 11,12 The benefits and drawbacks of using these adjuvants have been studied in several randomized controlled trials and meta-analyses. 11,13 In addition, the concept of "multimodal perineural analgesia (MMPNA)" has been introduced in recent animal safety and clinical observational studies.…”

“…A significant issue associated with single-shot peripheral nerve blocks (PNBs) is related to the limited duration of action of the presently available local anesthetics. Perineural administration of local anesthetic adjuvants, such as dexamethasone, fentanyl, dexmedetomidine, clonidine, and epinephrine, has been used to extend the duration of analgesia after PNB 11,12 . The benefits and drawbacks of using these adjuvants have been studied in several randomized controlled trials and meta-analyses 11,13 .…”

The effect of ultrasound-guided erector spinae plane block combined with dexmedetomidine for postoperative pain management in lumbar spine surgery: A case-based discussion

“…It has been shown that the use of multimodal anesthesia by improving analgesia reduces the use of intraoperative and postoperative opioids (3). A growing body of evidence supports the adjuvant use of dexmedetomidine in locoregional anesthesia significantly prolongs the analgesia and potentiates the effect, without clinically significant side effects (4,5).…”