This study evaluates the effect of adding dexmedetomidine as an adjuvant to bupivacaine in patients undergoing thoracotomy when administered peri-neurally in thoracic paravertebral space.
Thoracotomy is associated with severe postoperative pain that could be reduced with an aggressive analgesic therapy in the early postoperative period. The use of thoracic paravertebral block is an effective analgesic approach for post-thoracotomy pain. Several local anesthetic adjuvants have been reported to extend the duration of paravertebral block. Alpha-2 agonists including dexmedetomidine appear to be the most effective in this context. The study will include an intervention group which will receive a combination of 20 ml bupivacaine 0.5% and dexmedetomidine 0.5 ml (50 microgram). The control group will receive 20 ml bupivacaine 0.5% plus 0.5 ml normal saline perineurally. Thoracic paravertebral catheter will be inserted preoperatively. Visual analogue pain score will be assessed at different intervals.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
40
perineural dexmedetomidine as an adjuvant to bupivacaine induced thoracic paravertebral block
perineural bupivacaine saline mixture in the thoracic paravertebral catheter
Kasr Alainy Hospital Cairo University
Giza, Egypt
Duration of first loading preoperative dose of paravertebral injectate
Time interval between initiation of the paravertebral block and the time to first rescue analgesia
Time frame: One day
Duration of surgery and anesthesia
Times from start of anesthesia and surgery to the conclusion of surgical intervention
Time frame: Intraoperative period, up to 3-4 hours
End tidal isoflurane
Average End-tidal isoflurane concentration required to maintain stable hemodynamics
Time frame: Duration of anesthesia, up to 3-4 hours
Total intraoperative fentanyl requirements
The total dose of fentanyl required during the surgical procedure to maintain hemodynamic stability
Time frame: Intraoperative period, up to 3-4 hours
Total intraoperative ephedrine and atropine requirements
The total amounts of ephidrine and atropine required for the treatment of possible reduction of arterial blood pressure or heart rate
Time frame: Intraoperative period, up to 3-4 hours
Total intraoperative crystalloid requirements
The total volume of intraoperative fluids in ml required to maintain hemodynamic stability
Time frame: Intraoperative period, up to 3-4 hours
Recovery time
the time interval between discontinuation of isoflurane and the patient first response to verbal commands
Time frame: Immediate postoperative period, up to 2 hour
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Pain intensities at rest and during coughing as assessed by 0-10 VAS score
Pain scores will be assessed using the 11-points visual analogue pain score (VAS) where 0 indicates no pain and 10 indicates the worst pain.
Time frame: Over 48 hours postoperatively
Total doses of bupivacaine, dexmedetomidine, and morphine
The total doses of three medications will be recorded and compared in the intervention and control groups
Time frame: 48 hours postoperatively
Number of paravertebral to-up injections
The number of to-up doses of bupivacaine required to maintain adequate postoperative analgesia over 48 hours postoperatively
Time frame: 48 hours postoperatively
Side effects
Patients will be monitored for the possible reductions in arterial blood pressure and heart rate
Time frame: 48 hours postoperatively