Drug Design, Development and Therapy (May 2022)
Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial
Abstract
Jing Yang,1 Min Zhao,1 Xiao-Rui Zhang,1 Xiao-Rui Wang,1 Zhi-Hao Wang,1 Xiao-Yue Feng,2 Ya-Juan Lei,1 Jian-Wen Zhang1,3 1Department of Anesthesiology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China; 2Department of Pain Management, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of China; 3Department of Day Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, People’s Republic of ChinaCorrespondence: Jian-Wen Zhang, Department of Anesthesiology and Department of Day Surgery, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical University, Tongji Shanxi Hospital, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, People’s Republic of China, Tel +86 13994299284, Email [email protected]: This study aimed to investigate the effect of ropivacaine with dexmedetomidine or dexamethasone in a thoracic paravertebral nerve block (TPVB) combined with an erector spinae plane block (ESPB) for thoracoscopic lobectomy analgesia.Methods: A total of 97 patients undergoing thoracoscopic lobectomy under general anesthesia were enrolled in this study and randomly divided into three groups, ie, a ropivacaine group (Group R), a ropivacaine + dexmedetomidine group (Group R1), and a ropivacaine + dexamethasone group (Group R2). Ultrasound-guided TPVB combined with an erector spinae plane block was given after anesthesia induction. The following were applied to each group: Group R received 30 mL of 0.5% ropivacaine + 5 mL of a normal saline mixture; Group R1 received 30 mL of 0.5% ropivacaine + 5 mL of a 1 μg/kg dexmedetomidine mixture; Group R2 received 30 mL of 0.5% ropivacaine + 5 mL of an 8 mg dexamethasone mixture. The primary observation index was the time to the first postoperative remedial analgesia. The secondary observation indexes were the intraoperative consumption of propofol and sufentanil, time to waking from anesthesia, time to extubation, postoperative numerical rating scaltpe (NRS) score, postoperative sufentanil consumption, remedial analgesic dosage, and adverse reactions.Results: When compared with Group R, the time to first postoperative remedial analgesia was longer, the intraoperative and postoperative sufentanil consumption and flurbiprofen axetil remedial analgesic dose were lower, and the time to waking from anesthesia and time to extubation were shorter in groups R1 and R2 (P < 0.05). The NRS scores at 1, 6, 12, and 24 h postoperatively in groups R1 and R2 were lower than in Group R at the same time points (P < 0.05).Conclusion: Ropivacaine with dexmedetomidine or dexamethasone in TPVB combined with ESPB could prolong the time to first postoperative remedial analgesia, reduce perioperative sufentanil and postoperative remedial analgesic drug consumption, and decrease the postoperative NRS score in patients undergoing thoracoscopic lobectomy.Keywords: ropivacaine, local anesthetic adjuvant, dexmedetomidine, dexamethasone, thoracic paravertebral nerve block, erector spinae plane block, thoracoscopic surgery, perioperative analgesia
