Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in erector spinae plane block combined with serratus anterior plane block for thoracoscopic surgery: a prospective, randomized controlled trial.

BACKGROUND

We aimed to investigate the effect of dexamethasone and dexmedetomidine in erector spinae plane block combined with serratus anterior plane block for thoracoscopic postoperative analgesia.

METHODS

Ninety-six patients undergoing thoracoscopic surgery were randomly divided into group R (0.375% ropivacaine + saline diluted to 40 mL), group RS (0.375% ropivacaine + 10 mg dexamethasone + normal saline diluted to 40 mL), group RM (0.375% ropivacaine + 1 μg/kg dexmedetomidine + normal saline diluted to 40 mL), and group RSM (0.375% ropivacaine + 10 mg dexamethasone + 1 μg/kg dexmedetomidine + normal saline diluted to 40 mL). All four groups underwent ultrasound-guided erector spinae plane block combined with serratus anterior plane block within 30 minutes before anesthesia induction. The primary outcome was duration of effective analgesia, defined as the time from the onset of block to the first use of PCIA. Secondary outcomes included postoperative NRS scores, opioid consumption, rescue analgesia, quality of recovery, and adverse effects.

RESULTS

The duration of effective analgesia for group RSM (1770.0 [858.0] min) was significantly longer than group R (975.0 [471.5] min, P<0.001), group RS (1072.0 [695.0] min, P<0.05) and group RM (1340.0 [630.0] min, P<0.05). Group RSM also lowered postoperative pain scores, reduced opioid consumption and rescue analgesia, and improved quality of recovery compared with group R, group RS and group RM (all P<0.05). There was no significant difference in adverse effects, except that less nausea and vomiting were observed in group RSM (P<0.05).

CONCLUSIONS

Dexamethasone and dexmedetomidine as adjuvants to local anesthetic mixture in erector spinae plane block combined with serratus anterior plane block could prolong the duration of effective analgesia after thoracoscopic surgery.