AUTHOR=Gao Xiujuan , Zhao Tonghang , Xu Guangjun , Ren Chunguang , Liu Guoying , Du Ke 

TITLE=The Efficacy and Safety of Ultrasound-Guided, Bi-Level, Erector Spinae Plane Block With Different Doses of Dexmedetomidine for Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.577885

DOI=10.3389/fmed.2021.577885

ISSN=2296-858X

ABSTRACT=<p><bold>Background:</bold> The anesthetic characteristics of ultrasound-guided bi-level erector spinae plane block (ESPB) plus dexmedetomidine (Dex) remain unclear. We compared the efficacy and safety of ultrasound-guided bi-level ESPB plus different doses of Dex in patients undergoing video-assisted thoracic surgery (VATS).</p><p><bold>Methods:</bold> One-hundred eight patients undergoing VATS were randomized into three groups: R group (<italic>n</italic> = 38, 15 ml of 0.375% ropivacaine with 0.1 mg/kg dexamethasone), RD1 group (<italic>n</italic> = 38, 15 ml of 0.375% ropivacaine plus 0.5 μg/kg DEX with 0.1 mg/kg dexamethasone) and RD2 group (<italic>n</italic> = 38, 15 ml of 0.375% ropivacaine plus 1.0 μg/kg DEX with 0.1 mg/kg dexamethasone). The primary outcome was the pain 12 h after surgery. Secondary outcomes included the Prince Henry Hospital Pain Score; hemodynamics; consumption of sufentanil; anesthetized dermatomal distribution; recovery time; rescue analgesia; satisfaction scores of patients and surgeon; quick recovery index; adverse effects; the prevalence of chronic pain and quality of recovery.</p><p><bold>Results:</bold> The visual analog scale (VAS) and the Prince Henry pain score were significantly lower in both the RD1 and RD2 groups during the first 24 h after surgery (<italic>P</italic> 
&lt; 0.05). Both VAS with coughing and the Prince Henry pain score were significantly lower in the RD2 group than in the RD1 group 8–24 h after surgery (<italic>P</italic> &lt; 0.05). Both heart rate and mean arterial pressure were significantly different from T2 to T6 in the RD1 and RD2 groups (<italic>P</italic> &lt; 0.05). The receipt of remifentanil, propofol, Dex, and recovery time was significantly reduced in the RD2 group (<italic>P</italic> &lt; 0.05). The requirement for sufentanil during the 8–72 h after surgery, less rescue medication, and total press times were significantly lower in the RD2 group (<italic>P</italic> &lt; 0.05). The time to the first dose of rescue ketorolac was significantly longer in the RD2 group (<italic>P</italic> &lt; 0.05). Further, anal exhaust, removal of chest tubes, and ambulation were significantly shorter in the RD2 group (<italic>P</italic> &lt; 0.05). The incidence of tachycardia, post-operative nausea and vomiting, and chronic pain was significantly reduced in the RD2 group, while the QoR-40 score was significantly higher in the RD2 group (<italic>P</italic> &lt; 0.05).</p><p><bold>Conclusions:</bold> Pre-operative bi-level, single-injection ESPB plus 1 μg/kg DEX provided superior pain relief and long-term post-operative recovery for patients undergoing VATS.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn/searchproj.aspx" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.chictr.org.cn/searchproj.aspx</ext-link>.</p>