IV dexamethasone efficacious adjunct to Ultrasound-Guided Paravertebral Block in thoracoscopic surgery

BANGKOK: In a study published in the Journal of Pain Research, intravenous dexamethasone used in conjunction with a single injection of an ultrasound-guided thoracic paravertebral block (USG-TPVB) after video-assisted thoracoscopic surgery increased the duration of analgesia, had an opioid-sparing effect, and improved postoperative pain relief.

When performing video-assisted thoracoscopic surgery, the thoracic paravertebral block (TPVB) is advised regional analgesia. Acute postoperative pain alleviation from a single injection of TPVB is not long-lasting enough. It is technically challenging and frequently unreliable to do continuous TPVB with a catheter. With some peripheral nerve blocks, intravenous dexamethasone prolongs the duration of the analgesic. However, there is little information available on the impact of intravenous dexamethasone on TPVB pain relief.

In this study, individuals who got a thoracic paravertebral block for video-assisted thoracoscopic surgery had their intravenous dexamethasone analgesic efficacy evaluated.

In this multicenter prospective randomized controlled trial, the investigators enrolled patients between the ages of 18 and 80 who underwent elective VATS and had an American Society of Anesthesiologists physical status class of 1 through 3. In total, 59 patients were analyzed. Participants under general anesthesia were given either 8 mg of intravenous dexamethasone (group D) or saline at random (group C). 29 patients were included in group D and 30 patients in group C . The T4-T5 and T6-T7 spaces underwent ultrasound-guided TPVB (USG-TPVB). For both study groups, multimodal analgesia was produced using paracetamol, tramadol, and intravenous morphine. Time for the first analgesic need was the main result. They evaluated postoperative pain using a numeric rating scale (NRS), total morphine intake, and postoperative nausea and vomiting (PONV).

Conclusive points of the study:

• There were no intergroup variations in the baseline traits.
• In comparison to group C (270 [180, 300] minutes), group D (305 [240, 510] minutes) required more time before the first analgesic was needed (P value = 0.02).
• At 12 hours, group D's numeric rating score at rest and on movement was lower than group C's, but other time points did not show a difference.
• At 6, 12, 24, and 48 hours after surgery, group D had significantly less postoperative morphine utilization than group C.
• Postoperative nausea and vomiting occurrences were comparable across the groups.
• Of the patients in both groups, 18% experienced intraoperative hypotension.
• Similar amounts of fentanyl were consumed during surgery in both groups.
• Men and women react to pain differently, with women generally being more sensitive to pain and more likely to have clinical pain.

For better postoperative pain treatment following video-assisted thoracoscopic surgery, the authors advocated adding intravenous dexamethasone in addition to multimodal analgesia for an ultrasound-guided thoracic paravertebral block with bupivacaine.

REFERENCE

Termpornlert S, Vijitpavan A, Ngodngamthaweesuk M, Sangkum L, Saeaeh L, Pipatpongsa B, Leurcharusmee P, Wanishpongpan S, Sakura S. Analgesic Efficacy of Intravenous Dexamethasone as an Adjunct to Ultrasound-Guided Paravertebral Block with Bupivacaine in Video-Assisted Thoracoscopic Surgery. J Pain Res. 2022;15:2351-2361

https://doi.org/10.2147/JPR.S372780