The aim of this study is to compare the role of dexmedetomidine and ketamine as an adjuvant in external oblique intercostal plane block for post thoracotomy pain.
Postsurgical pain in patients who have undergone open thoracotomy for lung cancer or other lung surgeries is known to be very severe. As a result, this pain alters spontaneous breathing, delays postoperative recovery, and persists as chronic post-thoracotomy pain syndrome . Post-thoracotomy pain syndrome is relatively common and is seen in approximately 50% of patients after thoracotomy. It is a chronic condition, and about 30% of patients might still experience pain 4 to 5 years after surgery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
40
Patients will receive external oblique intercostal plane block using 29 ml bupivacaine 0.25% + 1 ml ketamine (50 mg) after induction of general anesthesia.
Patients will receive external oblique intercostal plane block using 29 ml bupivacaine 0.25% + 1 ml dexmedetomidine 0.5 μg/kg after induction of general anesthesia.
29 ml bupivacaine 0.25%
Tanta University
Tanta, ElGharbia, Egypt
Time to the 1st rescue analgesia
A standardized analgesic regimen will be prescribed in the post-operative period. All patients will receive paracetamol 1 gm every 6 h as routine analgesia. Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS) \> 3 to be repeated after 30 min if pain persists until the NRS \< 4. NRS will be assessed at 0, 4, 8, 12, 18, 24, 36 and 48 h postoperatively.
Time frame: 48 hours postoperative.
Intraoperative fentanyl consumption
Additional fentanyl bolus dosages of 1 µg/kg IV will be administered if heart rate or mean arterial blood pressure elevated more than 20% of the baseline (after exclusion of other causes than pain).
Time frame: Intraoperative
Total morphine consumption in the 1st 24hr and 48 hr
Rescue analgesia of morphine will be given as 3 mg bolus if the numeric rating scale (NRS)\> 3 to be repeated after 30 min if pain persists until the NRS \< 4. NRS will be assessed at 0, 4, 8, 12, 18, 24, 36 and 48 h postoperatively. NRS (0 represents "no pain" while 10 represents "the worst pain imaginable")
Time frame: 48 hours postoperatively.
Degree of pain
Degree of pain will be assessed by the numeric rating scale (NRS). NRS (0 represents "no pain" while 10 represents "the worst pain imaginable"). It will be assessed at 0, 4, 8, 12, 18, 24, 36 and 48 h postoperatively.
Time frame: 48 hours postoperatively.
Heart rate
Heart rate will be recorded preoperative, before performing of block, and every 15 min till the end of surgery.
Time frame: Till the end of surgery.
Mean arterial blood
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Mean arterial blood will be recorded preoperative, before performing of block, and every 15 min till the end of surgery.
Time frame: Till the end of surgery.
The incidence of adverse events
Adverse events such as pneumothorax, local anesthetic systemic toxicity (LAST), bradycardia, hypotension, nausea, vomiting, respiratory depression, or any other complication.
Time frame: 48 hours postoperative