Effect of Continuous Paravertebral Dexmedetomidine Administration on Intraoperative Anesthetic Drug Requirement and Post-Thoracotomy Pain Syndrome After Thoracotomy: A Randomized Controlled Trial

Published:August 20, 2016DOI:


      To assess the effect of paravertebral administration of dexmedetomidine as an adjuvant to local anesthetic on the intraoperative anesthetic drug requirement and incidence of post-thoracotomy pain syndrome.


      Prospective, randomized, controlled, double-blind trial.


      Single university hospital.


      The study comprised 30 patients who underwent elective thoracotomy and were assigned randomly to either the Ropin or Dexem group (n = 15 each).


      All patients received the study medications through paravertebral catheter. Patients in the Ropin group received a bolus of 15 mL of 0.75% ropivacaine over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine at 0.1 mL/kg/hour. Patients in the Dexem group received 15 mL of 0.75% ropivacaine plus dexmedetomidine, 1 µg/kg bolus over 3-to-5 minutes followed by an infusion of 0.2% ropivacaine plus 0.2 µg/kg/hour of dexmedetomidine at 0.1 mL/kg/hour.

      Measurements and Main Results

      The primary outcome of the study was intraoperative anesthetic drug requirement. The secondary outcome was the incidence of post-thoracotomy pain syndrome 2 months after surgery. The amount of propofol required for induction of anesthesia was significantly less in the Dexem group (Dexem 49.33±20.51 v 74.33±18.40 in the Ropin group, p = 0.002). End-tidal isoflurane needed to maintain target entropy was significantly less in the Dexem group at all time points. Intraoperative fentanyl requirement was lower in the Dexem group (Dexem 115.33±33.77 v 178.67±32.48 in the Ropin group, p = 0.002). Postoperative pain scores and morphine consumption were significantly less in the Dexem group (p<0.001). The incidence of post-thoracotomy pain syndrome was comparable between the 2 groups (69.23% v 50%, p = 0.496).


      Paravertebral dexmedetomidine administration resulted in decreased intraoperative anesthetic drug requirement, less pain, and lower requirements of supplemental opioid in the postoperative period. However, it had no effect on the incidence of post-thoracotomy pain syndrome.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Richardson J.
        • Sabanathan S.
        • Mearns A.J.
        • et al.
        Efficacy of preemptive analgesia and continuous extrapleural block on postthoracotomy pain and pulmonary mechanics.
        J Cardiovasc Surg. 1994; 35: 219-228
        • Richardson J.
        • Sabanathan S.
        • Shah R.
        Post-thoracotomy spirometric lung function: The effect of analgesia. A review.
        J Cardiovasc Surg. 1999; 40: 445-456
        • Davies R.G.
        • Myles P.S.
        • Graham J.M.
        A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and meta-analysis of randomized trials.
        Br J Anaesth. 2006; 96: 418-426
        • Pluijms W.A.
        • Steegers MAH
        • Verhagen AFTM
        • et al.
        Chronic post-thoracotomy pain: A retrospective study.
        Acta Anaesthesiol Scand. 2006; 50: 804-808
        • Wildgaard K.
        • Ravn J.
        • Kehlet H.
        Chronic post thoracotomy pain: A critical review of pathogenic mechanism and strategies for prevention.
        Eur J Cardio Thoracic Surg. 2009; 36: 170-180
        • Grewal S.
        • Hocking G.
        • Wildsmith J.A.W.
        Epidural abscesses.
        Br J Anaesth. 2006; 96: 292-302
        • Perttunen K.
        • Nilsson E.
        • Heinonen J.
        • et al.
        Extradural, paravertebral and intercostal nerve blocks for post-thoracotomy pain.
        Br J Anaesth. 1995; 75: 541-547
        • Dhole S.
        • Mehta Y.
        • Saxena H.
        • et al.
        Comparison of continuous thoracic epidural and paravertebral blocks for postoperative analgesia after minimally invasive direct coronary artery bypass surgery.
        J Cardiothorac Vasc Anesth. 2001; 15: 288-292
        • Bhana N.
        • Goa K.L.
        • McClellan K.J.
        Drugs. 2000; 59: 263-268
        • Jaakola M.L.
        • Salonen M.
        • Lehtinen R.
        • et al.
        The analgesic action of dexmedetomidine—a novel alpha2-adrenoceptor agonist—in healthy volunteers.
        Pain. 1991; 46: 281-285
        • Barletta J.F.
        • Miedema S.L.
        • Wiseman D.
        • et al.
        Impact of dexmedetomidine on analgesic requirements in patients after cardiac surgery in a fast-track recovery room setting.
        Pharmacotherapy. 2009; 29: 1427-1432
        • Salgado P.F.
        • Sabbag A.T.
        • Silva P.C.
        • et al.
        Synergistic effect between dexmedetomidine and 0.75% ropivacaine in epidural anesthesia.
        Rev Assoc Med Bras. 2008; 54: 110-115
        • Sinha S.
        • Mukherjee M.
        • Chatterjee S.
        • et al.
        Comparative study of analgesic efficacy of ropivacaine with ropivacaine plus dexmedetomidine for paravertebral block in unilateral renal surgery.
        Anaesth Pain Intensive Care. 2012; 16: 38-42
        • Mohamed S.A.
        • Fares K.M.
        • Mohamed A.A.
        • et al.
        Dexmedetomidine as an adjunctive analgesic with bupivacaine in paravertebral analgesia for breast cancer surgery.
        Pain Physician. 2014; 17: E589-E598
        • Riain S.C.O.
        • Donnill B.O.
        • Harmon D.C.
        • et al.
        Thoracic paravertebral block using real time ultrasound guidance.
        Anesth Analg. 2010; 110: 248-251
        • Chernik D.A.
        • Gillings D.
        • Laine H.
        • et al.
        Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: Study with intravenous midazolam.
        J Clin Psycho Pharmacol. 1990; 10: 244-251
        • Harsoor S.S.
        • Rani D.D.
        • Lathashree S.
        • et al.
        Effect of intraoperative dexmedetomidine infusion on sevoflurane requirement and blood glucose levels during entropy-guided general anesthesia.
        J Anaesthesiol Clin Pharmacol. 2014; 30: 25-30
        • Elhakim M.
        • Abdelhamid D.
        • Abdelfattach H.
        • et al.
        Effect of epidural dexmedetomidine on intraoperative awareness and post-operative pain after one-lung ventilation.
        Acta Anaesthesiol Scand. 2010; 54: 703-709
        • Guo T.Z.
        • Jiang J.Y.
        • Buttermann A.E.
        • et al.
        Dexmedetomidine injection into the locus coeruleus produces antinociception.
        Anesthesiology. 1996; 84: 873-881
        • El-Hennawy A.M.
        • Abd-Elwahab A.M.
        • Abd-Elmaksoud A.M.
        • et al.
        Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children.
        Br J Anaesth. 2009; 103: 268-274
        • Fares K.M.
        • Othman A.H.
        • Alieldin N.H.
        Efficacy and safety of dexmedetomidine added to caudal bupivacaine in pediatric major abdominal cancer surgery.
        Pain Physician. 2014; 17: 393-400
        • Saadawy I.
        • Boker A.
        • Elshahawy M.A.
        • et al.
        Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics.
        Acta Anaesthesiol Scand. 2009; 53: 251-256
        • Ramsay M.A.E.
        • Newman K.B.
        • Leeper B.
        • et al.
        Dexmedetomidine infusion for analgesia up to 48 hours after lung surgery performed by lateral thoracotomy.
        Proc (Bayl Univ Med Cent). 2014; 27: 3-10
        • Xiang Q.
        • Huang D.Y.
        • Zhao Y.L.
        • et al.
        Caudal dexmedetomidine combined with bupivacaine inhibit the response to hernial sac traction in children undergoing inguinal hernia repair.
        Br J Anaesth. 2013; 110: 420-424
        • Imabayashi T.
        • Ikoma K.
        • Kikuchi T.
        • et al.
        Heart rate variability during infusion of dexmedetomidine.
        Crit Care. 2011; 15: 352
        • Abdallah F.W.
        • Brull R.
        Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: A systematic review and meta-analysis.
        Br J Anaesth. 2013; 110: 915-925
        • Wu H.H.
        • Wang H.T.
        • Jin J.J.
        • et al.
        Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-Analysis.
        PLoS One. 2014; 9: e93114
        • Gottschalk A.
        • Cohen S.P.
        • Yang S.
        • et al.
        Preventing and treating pain after thoracic surgery.
        Anesthesiology. 2006; 104: 594-600
        • Perttunen K.
        • Tasmuth T.
        • Kalso E.
        Chronic pain after thoracic surgery: A follow-up study.
        Acta Anaesthesiol Scand. 1999; 43: 563-567