Objectives
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.
Design
Prospective, randomized, controlled, double-blind trial.
Setting
Single university hospital.
Participants
The study comprised 30 patients who underwent elective thoracotomy and were assigned
randomly to either the Ropin or Dexem group (n = 15 each).
Interventions
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).
Conclusions
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
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Publication history
Published online: August 20, 2016
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