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

Abstract

Background Management of postoperative pain after shoulder arthroscopy is an important issue. Dexmedetomidine, as an adjuvant, improves nerve block efficacy and decreases postoperative consumption of opioids. As a result, we designed this study to determine if adding dexmedetomidine to an erector spinae plane block (ESPB) that is guided by ultrasound (US) is beneficial for treating immediate postoperative pain following shoulder arthroscopy. Methods This randomized controlled double-blind trial recruited 60 cases 18–65 years old of both sexes, American Society of Anesthesiologists (ASA) physical status I-II, scheduled for elective shoulder arthroscopy. Random allocation of 60 cases was done equally into two groups according to the solution injected in US-guided ESPB at T2 before general anesthetic induction. Group (ESPB): 20 ml 0.25% bupivacaine. Group (ESPB + DEX): 19 ml bupivacaine 0.25% + 1 mL dexmedetomidine 0.5 µg/kg. The primary outcome was The total rescue morphine consumption in the first 24 postoperative hours. Results The mean intraoperative fentanyl consumption was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) (82.86 ± 13.57 versus 100.74 ± 35.07, respectively, P = 0.015). The median (IQR) time of the 1st rescue analgesic request was significantly delayed in the group (ESPB + DEX) compared to group (ESPB) [18.5 (18.25–18.75) versus 12 (12–15.75), P = 0.044]. The number of cases that required morphine was significantly lower in the group (ESPB + DEX) than in the group (ESPB) (P = 0.012). The median (IQR) of total postoperative morphine consumption in 1st 24 h was significantly lower in the group (ESPB + DEX) compared to the group (ESPB) [0 (0–0) versus 0 (0–3), P = 0.021]. Conclusion The dexmedetomidine as an adjuvant to bupivacaine in ESPB produced adequate analgesia by reducing the intraoperative and postoperative opioid requirements in shoulder arthroscopy. Trial Registration This study is registered on ClinicalTrials.gov (NCT05165836; principal investigator: Mohammad Fouad Algyar; registration date: 21/12/ 2021).

Dexmedetomidine with different concentrations added to local anesthetics in erector spinae plane block: a meta-analysis of randomized controlled trials

“…In the 13 trials with 430 patients in the DEX group and 393 in the control group, ESPB was performed at different levels. In one trial, it was performed at the level of the shoulder ( 37 ); in two trials, at the level of the lumbus and abdomen ( 35 , 36 ); and in 10 trials, at the level of the chest ( 7 – 9 , 34 , 38 – 43 ). The blocks provided surgical anesthesia in all 13 trials ( 7 – 9 , 34 – 43 ).…”

“…The blocks provided surgical anesthesia in all 13 trials ( 7 – 9 , 34 – 43 ). All trials used long-acting LAs, including levobupivacaine in one trial ( 43 ), bupivacaine in three trials ( 37 , 40 , 41 ), and ropivacaine in nine trials ( 7 – 9 , 34 – 36 , 38 , 39 , 42 ). DEX was used at a concentration of 0.5 μg/kg in three trials ( 9 , 37 , 40 ), 1 μg/kg in nine trials ( 7 , 8 , 34 – 36 , 38 , 41 – 43 ), and both concentrations in one trial ( 39 ).…”

“…All trials used long-acting LAs, including levobupivacaine in one trial ( 43 ), bupivacaine in three trials ( 37 , 40 , 41 ), and ropivacaine in nine trials ( 7 – 9 , 34 – 36 , 38 , 39 , 42 ). DEX was used at a concentration of 0.5 μg/kg in three trials ( 9 , 37 , 40 ), 1 μg/kg in nine trials ( 7 , 8 , 34 – 36 , 38 , 41 – 43 ), and both concentrations in one trial ( 39 ). Among them, four trials ( 7 , 34 , 38 , 43 ) also examined other adjuvants such as nalbuphine and dexamethasone, which arms were excluded from our analysis as unsuitable for the inclusion criteria.…”

Effects of epidurally administered dexmedetomidine and dexamethasone on postoperative pain, analgesic requirements, inflammation, and oxidative stress in thoracic surgery

“…The proper tube position was confirmed by auscultation and fiberoptic bronchoscopy. The ventilation settings during surgery were tidal volume ( 7-10 mL kg -1 (ideal body weight) ), a fraction of inspired oxygen (0.5-1.0), and end-tidal CO 2 partial pressure (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Following surgery, patients were admitted to the Intensive Care Unit (ICU).…”

“…Previously, Agamohammid et al observed that dexmedetomidine added to bupivacaine epidural infusion provides better pain control than bupivacaine alone (22). Hamed et al showed that adding dexmedetomidine in ultrasound-guided ESPB is associated with a better analgesic effect by reducing intraoperative fentanyl and postoperative morphine consumption with a more prolonged analgesic effect and stable hemodynamics (39). Also, Song and Lu in a meta-analysis of randomized controlled trials reported that dexmedetomidine administered before anesthesia in thoracoscopic surgery can substantially improve the analgesic efficacy (40).…”