Clinical evaluation of the analgesic efficacy of dexmedetomidine as an adjunction to erector spinae plane block during video-assisted thoracoscopic surgery

Introduction. Regional methods of analgesia are becoming increasingly popular in minimally invasive thoracic surgeries; however, their anesthetic effect is usually limited to 6–8 hours. Prolongation of analgesia is possible by using a combination of a local anesthetic solution and an adjuvant.

The objective was to evaluate the efficacy and safety of intravenous dexmedetomidine in combination with erector spinae plane block during video-assisted thoracoscopic (VATS) lung resection.

Materials and methods. A study was conducted involving 140 patients who underwent oncothoracic surgeries using video-assisted thoracoscopic technique. The patients were divided into 2 groups. In both groups, the erector spinae plane block (ESP block) was performed with 30 ml of 0.5% ropivacaine solution. In the 1st group (n = 70), 1 mcg/kg of dexmedetomidine was additionally administered intravenously. The intensity of postoperative pain syndrome was assessed after 1, 6, 12, 24 hours, the values of heart rate and systolic blood pressure, the need for vasopressors, the need for opioid analgesics, and potential adverse events were recorded.

Results. The pain intensity according to the NRS during the first 6 hours after surgery did not differ in patients of both groups. After 12 hours and 24 hours, the pain intensity was significantly lower in patients of group 1 (p < 0.001). After 6 hours after surgery, the total postoperative requirement for trimeperidine was lower in group 1: 20 [20–40] and 60 [40–80] mg, respectively (p = 0.001). The need for tramadol in patients of the 1st group was significantly lower compared to the 2nd group: 100 [100–200] mg and 200 [100–300] mg, respectively (p = 0.029). Hemodynamics in patients of both groups was stable. Administration of vasopressors was not required. Postoperative nausea and vomiting were not registered

Conclusion. Combined use of interfascial erector spinae plane block with 0.5% ropivacaine solution and intravenous administration of dexmedetomidine (1 mcg/kg) 20 minutes before the end of the operation in patients undergoing video-assisted thoracoscopic procedures, in a study conducted, it increased the duration of analgesia and reduced postoperative opioid analgesic consumption.

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