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

Abstract

Sivaporn Termpornlert,1 Amorn Vijitpavan,1 Montien Ngodngamthaweesuk,2 Lisa Sangkum,1 Lalisa Saeaeh,1 Benjaporn Pipatpongsa,1 Prangmalee Leurcharusmee,3 Samon Wanishpongpan,3 Shinichi Sakura4 1Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Cardiovascular Thoracic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Anesthesiology, Faculty of Medicine Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand; 4Department of Anesthesiology, University Hospital Shimane University Faculty of Medicine, Izumo, JapanCorrespondence: Sivaporn Termpornlert; Amorn Vijitpavan, Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, Tel [phone], Fax [phone], Email [email protected]; [email protected]: Thoracic paravertebral block (TPVB) is a recommended regional analgesia during video-assisted thoracoscopic surgery (VATS). However, single-injection TPVB does not last long enough to provide sufficient acute postoperative pain relief. Continuous TPVB through a catheter is technically challenging and often unreliable. Intravenous dexamethasone extends the analgesic duration with some peripheral nerve blocks. However, data on the effect of intravenous dexamethasone on pain relief with TPVB are limited. This study aimed to assess the analgesic efficacy of intravenous dexamethasone in patients who received TPVB for VATS.Patients and Methods: In this multicenter prospective randomized controlled trial, we recruited patients aged between 18 and 80 years with the American Society of Anesthesiologists of physical status class 1– 3 and underwent elective VATS. Patients under general anesthesia randomly received 8 mg of intravenous dexamethasone (group D) or normal saline (group C). Ultrasound-guided TPVB (USG-TPVB) was performed at the T4–T5 and T6-T7 spaces. Multimodal analgesia was achieved via paracetamol, tramadol and intravenous morphine for both study groups. The primary outcome was time for the first analgesic requirement. Postoperative pain in terms of numeric rating score (NRS), total morphine consumption and postoperative nausea and vomiting (PONV) were assessed.Results: After excluding one patient, 59 patients were analyzed. There were no intergroup differences in baseline characteristics. The time to first analgesic requirement was longer in group D (305 [240, 510] minutes) than in group C (270 [180, 300] minutes) (P value = 0.02). The NRS at rest and on movement was lower in group D than in group C at 12 hours but did not differ at other time points. Postoperative morphine consumption was significantly lower in group D than in group C at 6,12,24 and 48 hours. Incidences of PONV were comparable between the groups.Conclusion: Intravenous dexamethasone, used as an adjunct to a single-injection USG-TPVB prolonged analgesic duration, had an opioid-sparing effect and provided better postoperative pain relief after VATS.Keywords: thoracic paravertebral block, analgesic duration, postoperative pain, opioid-sparing effect

Keywords

• thoracic paravertebral block
• analgesic duration
• postoperative pain
• opioid-sparing effect