Effect of dexmedetomidine as an adjuvant in erector spinae plane block on postoperative analgesia in thoracolumbar spine surgery with an opioid free anaesthesia technique: A prospective randomized clinical trial.

BACKGROUND

Spine surgery is associated with intense postoperative pain, necessitating effective analgesia for optimal postoperative outcome. This study aimed to evaluate the analgesic efficacy of dexmedetomidine as an adjuvant in ultrasound guided erector spinae plane block (ESPB) in patients undergoing thoracolumbar spine surgery using opioid-free anaesthesia (OFA). The postoperative pain free period was primary outcome, and pain scores, 24-hour rescue analgesic requirements, qNOX values for intraoperative analgesia, perioperative hemodynamics and overall patient satisfaction score were secondary outcomes.

METHODOLOGY: This prospective double-blind randomized trial enrolled 40 patients aged 18--65 years undergoing T8-L3 spine surgery. The patients were randomly allocated to the following groups: Group RD [0.2% ropivacaine (0.5 ml/kg) and dexmedetomidine (1 µg/kg)] and Group R [0.2% ropivacaine (0.5 ml/kg) only]. Following onset of ESPB block, patients were given general anaesthesia using Ketofol infusion (1 ml Ketofol contains 8.33 mg of Propofol + 1.67 mg of Ketamine) under qCON and qNOX monitoring.

RESULTS

Group RD demonstrated statistically significant extended pain-free period (15 vs 8.3 h, P = 0.001) and reduced pain scores at 4th, 6th, and 8th hours compared to Group R (P = 0.015, 0.001, 0.001 respectively). Lower 24-hour second-line rescue analgesic needs (P = 0.001) and increased patient satisfaction (P = 0.001) were observed in Group RD compared to Group R. However, intraoperative hemodynamics and analgesia were comparable in both the groups (p > 0.05).

CONCLUSION

The addition of dexmedetomidine with ESPB was associated with improved postoperative analgesia, reduced requirement for second-line rescue analgesia and increased patient satisfaction following thoraco-lumbar spine surgery with OFA using Ketofol.