RT Journal Article
SR Electronic
T1 Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in intercostal nerve block for thoracoscopic pneumonectomy: a prospective randomized study
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP rapm-2018-100221
DO 10.1136/rapm-2018-100221
A1 Panpan Zhang
A1 Shijiang Liu
A1 Jingming Zhu
A1 Zhuqing Rao
A1 Cunming Liu
YR 2019
UL http://rapm.bmj.com/content/early/2019/08/08/rapm-2018-100221.abstract
AB 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.