This study aimed to evaluate the effect of fentanyl versus dexmedetomidine as adjuvants to bupivacaine with comparison to bupivacaine alone in ultrasound-guided erector spinae plane block on the quality and duration of pain control in patients undergoing arthroscopic shoulder surgeries.
Shoulder arthroscopic surgery is one of the most common surgical procedures performed in daily practice, for many surgical indications as rotator cuff tears, stiffness and instability, this procedure has a well - documented postoperative pain. The erector spinae plane block (ESPB) is one of the emerging regional techniques for managing postoperative pain. ESPB has been used successfully in many surgeries such as mastectomy, thoracotomies, percutaneous nephrolithotomies, lumbar fusions, hernia repair, cesarean delivery and even in total hip arthroplasty. Fentanyl as an additive to 0.25% bupivacaine in paravertebral block has been found to reduce the rescue analgesic consumption as well as cumulative pain scores at rest and on movement after breast surgery. Dexmedetomidine is highly selective than clonidine, specific and potentα2-adrenergic agonist having analgesic, sedative, antihypertensive, and anesthetic sparing effects when used in systemic route.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
90
Patients received ultrasound-guided erector spinae plane block (ESPB) using 20 cc of 0.25% bupivacaine at T2.
Patients received ultrasound-guided erector spinae plane block (ESPB) using a total volume of 20 ml (bupivacaine 0.25% + Fentanyl 1µg/kg) at T2.
Patients received ultrasound-guided erector spinae plane block (ESPB) using a total volume of 20 ml (bupivacaine 0.25% + dexmedetomidine 1µg/kg) at T2.
Tanta University
Tanta, El-Gharbia, Egypt
Degree of pain
Assessment of postoperative pain was done with numerical rate scale \[numerical rate score (NRS); 0=no pain and 10=worst possible pain\]. At post-anesthesia care unit (PACU) then 2, 4, 6, 8, 12, and 24 hours postoperative.
Time frame: 24 hours postoperatively
Time of first rescue analgesia
Time of first rescue analgesia was recorded from the end of surgery till the first dose of morphine adminstrated.
Time frame: 24 hours postoperatively
Intraoperative fentanyl consumption
Any intraoperative hypertension (mean arterial pressure\>20% of baseline) or tachycardia were managed by rescue fentanyl dose 1µg /kg IV when suspected to be caused by intraoperative pain awareness and these cases was recorded.
Time frame: Intraoperatively
Total amount of morphine consumption
Rescue analgesia in the form of 3 mg IV morphine was given if the numerical rate score (NRS) is ≥ 4 repeated with 10 minutes lockout interval till the (NRS) becomes less than 3.
Time frame: 24 hours postoperatively
Length of hospital stay
Length of hospital stay was recorded from the admission till the discharge from hospital.
Time frame: Till the discharge from hospital (Up to 2 weeks)
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