Intravenous Dexamethasone and Dexmedetomidine on the Analgesic Efficacy of Erector Spinae Plane Block
Condition: Dexamethasone; Dexmedetomidine; Nerve Block
Study type: Interventional

Summary: 
      Patients having lumbar spinal fusion often complain about severe postoperative pain and
      postoperative rehabilitation process can be affected negatively. Postoperative pain that
      cannot be well controlled may lead to delayed mobilization, pulmonary and thromboembolic
      complications, prolonged hospital stays, and chronic pain syndromes. Pain after spinal
      surgery can arise from several different tissues, such as the vertebrae, disks, ligaments,
      dura, facet joint, muscle, fascia, and subcutaneous and cutaneous tissues.

      Ultrasound-guided lumbar erector spinae plane block (ESPB) has been shown to reduce
      postoperative pain in patients undergoing posterior lumbar interbody fusion (PLIF). However,
      the duration of analgesia after single-shot ESPB with commonly used local anesthetics is
      reported to be no more than 12 h, which often not long enough to provide satisfactory
      postoperative pain relief, as the pain typically lasts for several days. Compared with
      perineural route, intravenous additives to local anesthetics are commonly accepted as its
      safety and efficiency have been reported. Moreover, co-administration of intravenous
      dexamethasone and dexmedetomidine significantly prolonged the time to ﬁrst rescue analgesic
      request after single-shot interscalene brachial plexus block. However, more data are needed
      especially for lumbar ESPB.
    


Intervention name(s): Dexamethasone and dexmedetomidine; Dexmedetomidine; Ultrasound-guided lumbar erector spinae plane block; PCIA
Intervention type(s): Drug; Drug; Other; Other
Intervention description(s): General anesthesia was induced with sufentanil 0.5-0.8 ug/kg, propofol 1.5-2.0 mg/kg, and rocuronium 0.5-1.0 mg/kg. Intravenous dexamethasone 10 mg was injected and a 50-ml syringe containing dexmedetomidine 1 ug/kg in 0.9% saline was infused after induction of general anaesthesia over a 30-min period. Anesthesia was maintained by remifentanil and sevoflurane to keep the Narcotrend index reading between 40 and 60.; Intravenous dexmedetomidine 1 ug/kg was infused after induction of general anaesthesia over a 30-min period.; The probe was installed in the sagittal axis in the midline at the L3 vertebral level. The spinous processes were ﬁrst visualized, after which the probe was lateralized, and the transverse processes and the erector spinae muscle were visualized approximately 3 cm laterally to the midline. The needle was advanced between the transverse process and the deep fascia of the erector spinae muscle from the caudal to the cranial using in-plane technique. The location of the needle was confirmed with 2mL saline solution, after which 20 mL of 0.4% ropivacaine was administered.; Intravenous PCA included 0.9% saline with sufentanil and was programmed to run at 2ml with a 1-ml bolus dose and a 10-min lockout time. The patients with VAS more than 4 despite using intravenous PCA were treated with rescue analgesics comprising intravenous parecoxib.
Intervention MeSH terms: Dexamethasone; Dexmedetomidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment