Thoracic Paravertebral Nerve Block with Ropivacaine and Adjuvant Dexmedetomidine Produced Longer Analgesia in Patients Undergoing Video-Assisted Thoracoscopic Lobectomy: A Randomized Trial

Abstract

Purpose. This study evaluated the postoperative analgesic effect of ultrasound-guided single-point thoracic paravertebral nerve block (TPVB) combined with dexmedetomidine (DEX) in patients undergoing video-assisted thoracoscopic lobectomy. Methods. Sixty adult patients of the American Society of Anesthesiologists (ASA) I–III were randomly assigned into three groups (n = 20 each). G group: patients received routine general anesthesia; PR group: patients received 0.5% ropivacaine; and PRD group: patients received 0.5% ropivacaine with 1 μg/kg DEX. TPVB was performed in the T5 space before surgery, and then, general anesthesia induction and video-assisted thoracoscopic lobectomy were performed. Analgesics were administered through the patient-controlled analgesia (PCA) device intravenously. The background infusion of each PCA device was set to administer 0.02 μg/kg/h sufentanil, with a lockout time of 15 min, and a total allowable volume is 100 ml. Results. Compared to PR and G groups, the total sufentanil consumption after operation, the times of analgesic pump pressing, the pain score, and the incidence of postoperative nausea or vomiting in the PRD group were significantly reduced ( p < 0.05 ). Also, the duration of first time of usage of the patient-controlled analgesia (PCA) was longer. The heart rate (HR) and mean arterial pressure (MAP) during operation were lower in the PRD group as compared with the other two groups in most of the time. However, hypotension and arrhythmia occurred in three groups with no statistically significant difference. Conclusions. A small volume of TPVB with ropivacaine and DEX by single injection produced longer analgesia in patients undergoing video-assisted thoracoscopic lobectomy, reduced postoperative opioids consumption, and the incidence of side effects.

Evidence basis for using dexmedetomidine to enhance the quality of paravertebral block: A systematic review and meta-analysis of randomized controlled trials

“…After reviewing the full text, 56 records were excluded because the study was not an RCT, the data were incomplete, or the interventions were inconsistent. A total of 12 full-text randomized trials ( Mohamed et al, 2014 ; Chen et al, 2015 ; Tian et al, 2015 ; Mohta et al, 2016 ; Dutta et al, 2017 ; Jin et al, 2017 ; Ding et al, 2018 ; Xu et al, 2018 ; Abd-Elshafy et al, 2019 ; Alimian et al, 2021 ; Sen et al, 2021 ; Zha et al, 2021 ) ultimately met the inclusion criteria for meta-analysis. The flowchart for the retrieval and filtering of records is shown in Figure 1 and summarizes the reasons for the exclusion of records.…”

“…The details of the 12 RCTs, surgical sites, interventions, sample sizes, and assessments of the primary outcomes are summarized in Table 1 . The nerve block localization methods were anatomical localization in one trial ( Mohamed et al, 2014 ), ultrasound localization in 10 trials ( Chen et al, 2015 ; Tian et al, 2015 ; Dutta et al, 2017 ; Jin et al, 2017 ; Ding et al, 2018 ; Xu et al, 2018 ; Abd-Elshafy et al, 2019 ; Alimian et al, 2021 ; Sen et al, 2021 ; Zha et al, 2021 ), and not defined in one trial ( Mohta et al, 2016 ). All trials used long-acting LAs (ropivacaine, bupivacaine, or levobupivacaine) alone.…”

“…Data describing the primary outcome, postoperative pain severity (postoperative pain scores), were obtained at 12 h in eight trials ( Mohamed et al, 2014 ; Mohta et al, 2016 ; Dutta et al, 2017 ; Jin et al, 2017 ; Ding et al, 2018 ; Xu et al, 2018 ; Alimian et al, 2021 ; Zha et al, 2021 ) and at 24 h in nine trials ( Mohamed et al, 2014 ; Mohta et al, 2016 ; Dutta et al, 2017 ; Jin et al, 2017 ; Ding et al, 2018 ; Xu et al, 2018 ; Abd-Elshafy et al, 2019 ; Alimian et al, 2021 ; Zha et al, 2021 ). We used the random effect model and took MD as the outcome index.…”

“…The effect of dexmedetomidine as an adjunct to PVB on the postoperative analgesia duration was assessed in 10 trials ( Mohamed et al, 2014 ; Chen et al, 2015 ; Tian et al, 2015 ; Mohta et al, 2016 ; Jin et al, 2017 ; Ding et al, 2018 ; Abd-Elshafy et al, 2019 ; Alimian et al, 2021 ; Sen et al, 2021 ; Zha et al, 2021 ). The duration of postoperative analgesia was defined as the time to first analgesia request.…”

“…Five trials ( Mohamed et al, 2014 ; Mohta et al, 2016 ; Jin et al, 2017 ; Alimian et al, 2021 ; Zha et al, 2021 ) reported cumulative analgesic consumption after surgery; cumulative analgesic consumption 48 h after surgery was expressed as oral morphine equivalent. The analysis results are shown in Table 3 .…”