Dexmedetomidine combined with ropivacaine for erector spinae plane block after posterior lumbar spine surgery: a randomized controlled trial

Abstract

Purpose Due to lumbar spinal surgery is frequently accompanied with moderate-to-severe postoperative pain, it is necessary to find an effective postoperative analgesia for patients with this surgery. This study aimed to observe the analgesic effect of dexmedetomidine combined with ropivacaine erector spinae plane block (ESPB) used in posterior lumbar spine surgery. Methods In this clinical trial, patients undergoing posterior lumbar spine surgery were recruited and randomly divided into two groups: intervention and control. The intervention group (Group E) received 0.375% ropivacaine with 1 µg/kg dexmedetomidine in a total of 20 ml for ESPB; the control group (Group C) received 20 ml ropivacaine 0.375% for ESPB. US-guided ESPB was performed preoperatively in all patients. Demographics, anesthesia time, surgery time, and ASA grade from the participants were recorded at baseline. The primary clinical outcome measures were 2-, 4-, 8-, 12-, 24-and 48-h visual analog scale (VAS) pain scores after surgery at rest and movement state. Other end points included opioid consumption, number of PCIA presses, flurbiprofen-axetil consumption, quality of recovery and pain management after surgery. Results One hundred twenty patients were enrolled in the study (mean [SD] ages: Group E, 54.77 [8.61] years old; Group C,56.40 [7.87] years old; P = 0.280). The mean anesthesia time was 152.55 (15.37) min in Group E and 152.60 (16.47) min in Group C (P = 0.986). Additionally, the surgery time was 141.70 (15.71) min in Group E compared to 141.48 (17.13) min in Group C (P = 0.943). In addition, we found that the VAS pain scores in the resting state during the postoperative period at 8–48 h were lower in Group E than in Group C. However, the VAS pain scores in the active state were lower in Group E at 12–48 h (P < 0.05). More importantly, the consumption of opioids and flurbiprofen-axetil after surgery was also lower in Group E (P < 0.05). Subsequently, we administered questionnaires on the quality of recovery and pain management after surgery that were positively correlated with the postoperative analgesic effect. It was worth affirming that the QoR-15 scores and APS-POQ-R questionnaire results were different between the two groups, further confirming that the combination of drugs not only could obtain an ideal analgesic effect but also had no obvious adverse reactions (P < 0.05). Conclusions All the findings suggested that dexmedetomidine could significantly relieve postoperative pain and reduce the consumption of opioids in patients undergoing posterior lumbar spine surgery without obvious adverse reactions as a local anesthetic adjuvant. Further studies with larger sample sizes and different drug dosages may be useful in understanding the potential clinical benefits of dexmedetomidine.

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

“…A sensitivity analysis was conducted to examine the source of heterogeneity. The pooled analysis results remained unchanged after excluding the data of Wang YH et al [ 25 ], but the heterogeneity was low (MD = -5.79; 95% CI = -7.24 to -4.35; p < 0.00001; I 2 = 0%; random-effects model; Fig. 5 ), indicating that this study is the main source of heterogeneity.…”

“…Four RCTs reported the number of PCIA presses within 72 h after the operation. The pooled analysis showed that DEX as adjuvants significantly reduced the number of PCIA presses (four studies [ 19 , 21 , 22 , 25 ]: MD = -4.12; 95% CI = -7.79 to -0.45; p = 0.03; I 2 = 93%; random-effects model; GRADE = Low; Fig. 4 ).…”

“…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 ].…”

“…The authors reviewed the full text of the remaining 29 relevant studies and excluded 21 studies from the final analysis because 7 studies were intravenous DEX, 10 studies were preclinical experiments and 4 studies were no ESPB was performed in the control group. Finally, 8 RCTs were included in the study [19][20][21][22][23][24][25][26]. Figure 1 represents the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow diagram, and summarizes the reasons for exclusion of records [13].…”