Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without Dexmedetomidine in Video-Assisted Thoracoscopic Surgery

Jianghui Xu, Xiaoyu Yang, Xiaobing Hu, Xiaofeng Chen, Jun Zhang, Yingwei Wang
Journal of Cardiothoracic and Vascular Anesthesia 2018, 32 (1): 318-324

OBJECTIVES: Thoracic paravertebral block (TPVB) is reported to have advantages in postoperative pain management in unilateral thoracic surgeries. Previous studies have demonstrated that dexmedetomidine could be used as an adjuvant to local anesthetics, with the aim of prolonging the duration of neural blockade. However, little is known about whether such a combination could improve the quality of postoperative analgesia compared with local anesthetic only when TPVB is used for patients undergoing video-assisted thoracoscopic surgery (VATS).

DESIGN: A prospective, randomized, controlled study.

SETTING: Single-center university hospital.

PARTICIPANTS: The study included 60 patients undergoing VATS under general anesthesia.

INTERVENTIONS: The patients were allocated randomly into the following 2 groups: 0.375% ropivacaine, 20 mL only (group R, n = 30), and 0.375% ropivacaine, 20 mL plus 1 μg/kg of dexmedetomidine (group RD, n = 30). At the end of surgery, TPVB guided using ultrasound was performed at 4 points-T4-5, T5-6, T6-7, and T7-8-of the surgical side; 5 mL of solution were injected at each point. Postoperatively, the intravenous nonsteroidal anti-inflammatory drug flurbiprofen was used as part of multimodal analgesia.

MEASUREMENTS AND MAIN RESULTS: Pain scores at rest and during coughing were evaluated by a blinded observer in the postanesthesia care unit postoperatively at 1, 2, 4, 8, 12, 24, 36, and 48 hours, and the dermatomal levels of sensory blockade, postoperative requirements for rescue analgesia, adverse events, and patient satisfaction also were recorded. There was a significant reduction in postoperative pain scores at rest starting from the postoperative 8th hour until the 48th hour and during coughing starting at the postoperative 4th hour until the 48th hour in the group RD compared with those in group R (p = 0.043). The dermatomal levels of sensory blockade were comparable in the 2 groups. Patient satisfaction after surgery was significantly higher in the group RD than in group R (p < 0.001). Total consumption of the intravenous rescue analgesic morphine and adverse events were not significantly different between the 2 groups.

CONCLUSIONS: Compared with ropivacaine only, the addition of dexmedetomidine, 1 μg/kg, to local anesthetic for multilevel TPVB in patients undergoing VATS prolonged the duration of postoperative analgesia and improved patient satisfaction without serious side effects when combined with postoperative intravenous nonsteroidal anti-inflammatory drug administration.

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