Thoracic Paravertebral Block with Adjuvant Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind Study

Abstract

Background: The addition of the adjuvant dexmedetomidine to a nerve block improves the quality of the block and reduces perioperative opioid consumption. The aim of this study was to assess the effect of dexmedetomidine as an adjuvant for the thoracic paravertebral block (TPVB) in postoperative pain control after video-assisted thoracoscopic surgery (VATS). Methods: Sixty-six males, aged 15–40 years, with spontaneous pneumothorax scheduled for VATS wedge resection were enrolled. Following surgery, ultrasound-guided TPVB was performed on the T3 and T5 levels with 30 mL of 0.5% ropivacaine, plus adjuvant dexmedetomidine 50 μg or normal saline. The primary outcome was cumulative fentanyl consumption at 24 h. Pain severity, the requirement for additional rescue analgesics, hemodynamic variations, and side effects were also evaluated. Results: Median postoperative cumulative fentanyl consumption at 24 h was significantly lower in the dexmedetomidine group (122.6 (interquartile range (IQR) 94.5–268.0) μg vs. 348.1 (IQR, 192.8–459.2) μg, p-value = 0.001) with a Hodges–Lehman median difference between groups of 86.2 (95% confidence interval (CI), 4.2–156.4) mg. Coughing numeric rating scale (NRS) was lower in the dexmedetomidine group at postoperative 2, 4, 8, and 24 h. However, resting NRS differed significantly only after 4 h postoperative. Conclusions: Dexmedetomidine as an adjunct in TPVB provided effective pain relief and significantly reduced opioid requirement in VATS.

Analgesic Efficacy of Ultrasound-Guided Paravertebral Block in Patients Undergoing Percutaneous Nephrolithotomy: A Randomised, Controlled Clinical Study

“…In the adjuvant therapy group, the maximum VAS pain scores for the 24 hour post-operative period while resting or when coughing were lower than those seen in the group receiving ropivacaine alone. This result attained statistical signi cance [15]. It seems that further research is needed to determine the optimal dose of local anaesthetics with or without adjuvant and to clarify the ideal timing to perform PVB, i.e.…”

“…Indeed, PVB, together with epidural anaesthesia, are considered Gold Standard procedures. Newer studies have focused on lengthening the duration of analgesia through the addition of adjuvant therapy, notably clonidine and dexmedetomidine [14,15].…”

Analgesic efficacy of ultrasound guided paravertebral block in percutaneous nephrolithotomy patients: a randomized controlled clinical study

“…In the adjuvant therapy group, the maximum VAS pain scores for the 24 h post-operative period while resting or when coughing were lower than those seen in the group receiving ropivacaine alone. This result attained statistical significance [ 14 ]. It seems that further research is needed to determine the optimal dose of local anaesthetics with or without adjuvant and to clarify the ideal timing to perform PVB, i.e.…”

“…Indeed, PVB, together with epidural anaesthesia, are considered Gold Standard procedures. Newer studies have focused on lengthening the duration of analgesia through the addition of adjuvant therapy, notably clonidine and dexmedetomidine [13,14].…”

Effect of intraoperative dexmedetomidine on postoperative pain and pulmonary function following video-assisted thoracoscopic surgery

“…[ 8 9 ] It combines analgesic, sedative and anxiolytic properties with preservation of respiratory function by its opioid-sparing effects. [ 9 10 11 12 13 14 ]…”