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Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study
  1. Panpan Zhang1,
  2. Shijiang Liu2,
  3. Jingming Zhu2,
  4. Zhuqing Rao2 and
  5. Cunming Liu2
  1. 1Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
  2. 2Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital), Nanjing, China
  1. Correspondence to Dr Cunming Liu, Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210029, China; 1335587409{at}; Dr Zhuqing Rao, Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210029, China; zhuqingrao{at}


Background and objectives Perineural dexamethasone or dexmedetomidine prolongs the duration of single-injection peripheral nerve block when added to the local anesthetic solution. In a randomized, controlled, double-blinded study in patients undergoing thoracoscopic pneumonectomy, we tested the hypothesis that combined perineural dexamethasone and dexmedetomidine prolonged the duration of analgesia as compared with either perineural dexamethasone or perineural dexmedetomidine after intercostal nerve block (INB).

Methods Eighty patients were randomized to receive INB using 28 mL 0.5% ropivacaine, with 2 mL normal saline (R group), with 10 mg dexamethasone in 2 mL (RS group) or 1 µg/kg dexmedetomidine in 2 mL (RM group), or with 1 µg/kg dexmedetomidine and 10 mg dexamethasone in 2 mL (RSM group) administrated perineurally. The INB was performed by the surgeon under thoracoscopic direct vision; a total of six intercostal spaces were involved, each with an injection of 5 mL. The primary outcome was the duration of analgesia. Secondary outcomes included total postoperative fentanyl consumption, visual analog scale pain score and safety assessment (adverse effects).

Results The duration of analgesia in RSM (824.2±105.1 min) was longer than that in RS (611.5±133.0 min), RM (602.5±108.5 min) and R (440.0±109.6 min) (p<0.001). Total postoperative fentanyl consumption was lower in RSM (106.0±84.0 µg) compared with RS (243.0±175.2 µg), RM (237.0±98.7 µg) and R (369.0±134.2 µg) (p<0.001). No significant difference was observed in the incidences of adverse effects between the four groups.

Conclusion The addition of combined perineural dexmedetomidine and dexamethasone to ropivacaine for INB seemed to be an attractive method for prolonged analgesia with almost no adverse effects.

Trial registration number ChiCTR-IOR-17012183.

  • dexamethasone
  • dexmedetomidine
  • intercostal nerve block
  • thoracoscopic pneumonectomy

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  • PZ and SL contributed equally.

  • ZR and CL contributed equally.

  • Contributors All authors helped design the study. PZ, ZR and CL helped conduct of the study. PZ, SL, ZR and CL helped recruit the patients. JZ, ZR and CL helped collect the data. PZ, SL, ZR and CL helped analyze the data. PZ, SL and CL was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (Nanjing, Jiangsu Province, China) and was prospectively registered on Chinese Clinical Trial Registry (registration number ChiCTR-IOR-17012183).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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