Role of dexamethasone in the para-vertebral block for pediatric patients undergoing aortic coarctation repair. randomized, double-blinded controlled study

Abstract

BackgroundSurgery for aortic coarctation requires special care during anesthesia due to severe pain during the lateral thoracotomy incision, intraoperative hemodynamic instability and the need for large doses of intra- and postoperative analgesics and vasodilators. Additionally, the postoperative care of patients is very important.AimsWe aimed to compare ultrasound-guided paravertebral block performed using bupivacaine alone and bupivacaine with dexamethasone in terms of the intra- and postoperative analgesic requirements and hemodynamics, postoperative complications and ICU stay.Study designThis was a prospective, randomized, controlled, double-blinded study.MethodsFifty patients aged four to 12 months scheduled for aortic coarctation surgery were randomly divided into two equal groups (n = 25). Patients in group D (dexamethasone) received 0.5 mg/kg bupivacaine 0.25% mixed with 0.1 mg/kg dexamethasone diluted with isotonic saline and those in group C (control) received 0.5 mg/kg bupivacaine 0.25% diluted with isotonic saline (total volume 15 ml in each group). Intraoperative fentanyl consumption and hemodynamics (heart rate, arterial blood pressure) at baseline, 1 min after induction, at skin incision, after 30 min, after clamping, after declamping and at the end of the surgery were recorded, along with the objective pain score (OPS) immediately postoperatively and at 4 h, 8 h, 12 h and 24 h postoperatively and the time to the first request for pethidine. The intra- and postoperative vasodilator doses, time to extubation, ICU stay duration and postoperative complications were also recorded.ResultsThe postoperative OPS was significantly lower at 12 and 24 h in group D than in group C. The time to the first request for analgesia was significantly longer in group D than in group C (3.9 ± 2.23 vs 8.6 ± 0.69). Additionally, the time to extubation was significantly shorter in group D.ConclusionThe use of dexamethasone as an adjuvant in ultrasound-guided paravertebral block in paediatric patients undergoing surgery for aortic coarctation increased the duration of postoperative analgesia with a prolonged time to the first request for analgesics It was also associated with a decreased incidence of postoperative complications.Trial registrationTrial registration number: NCT03074773. (Prospectively registered). The initial registration date was 9/3/2017.

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

“…In addition, our findings are consistent with those of Saleh and colleagues who investigated the combination of 0.1 mg/kg dexamethasone and 0.5 mg/kg bupivacaine 0.25% in PVB for pediatric patients undergoing repair of aortic coarctation. The study demonstrates the analgesic efficacy of dexamethasone as an adjuvant to bupivacaine and even contributed to early extubation 10 …”

“…The paravertebral region is a potential space that can be expanded by the injection of fluids, such as local anesthetic solutions, resulting in a wedge-shaped space that surrounds various neurological structures, including the anterior and posterior rami of the spinal nerve, and the white and gray rami communicates 7,8 . The efficacy of paravertebral block (PVB) in managing postoperative pain has been examined for adults 9 and pediatrics 10 in many trials with favorable outcomes. However, the surgical or transincisional routes for LPVB have not been extensively explored in the literature.…”

Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery: A Randomized Controlled Clinical Trial

“…Macaire et al found that catheters can eliminate morphine consumption, improving postoperative rehabilitation and pain scores [ 8 ]. In this single-shot study, the addition of dexamethasone to ropivacaine was based on previous reports demonstrating improved and prolonged duration (i.e., beyond 10 h) of postoperative analgesia [ 21 , 22 , 23 , 24 ]. The interventional group had a 63.5% decrease in 48 h morphine usage and significantly reduced pain scores up to 48 h after extubation.…”

Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery

“…Dexamethasone has also been administered perineurally with various peripheral nerve blocks. Mao et al 31 and Saleh et al 32 showed that perineural dexamethasone in TPVB prolongs the duration of analgesics and improves postoperative analgesia in thoracotomy. Previous studies have compared the analgesic duration of peripheral nerve blocks when dexamethasone was administered via various routes.…”