Erector Spinae Plane Block for Post-thoracotomy Pain Control
Condition: Post-thoracotomy Pain Syndrome
Study type: Interventional

Summary: 
      The thoracic epidural block (TEB) and thoracic paravertebral block (TPVB) are the most
      commonly used techniques for analgesia after thoracic surgery.Recently, erector spinae plane
      block (ESPB) was reported as a treatment for thoracic neuropathic pain.Dexmedetomidine has
      been primarily used for intra- venous sedation in intensive care settings. The unique
      analgesic properties of dexmedetomidine have encouraged the anesthesiologists to use it
      perineurally.

      This study aims to evaluate the effect ultrasound erector spinae plane block with
      dexmedetomidine infusion in management of acute and chronic post thoracotomy pain.
    

Detailed description: 
      The thoracic epidural block (TEB) and thoracic paravertebral block (TPVB) are the most
      commonly used techniques for analgesia after thoracic surgery. However, TEA has several
      adverse effects, such as hypotension, motor blockade, hematoma, and abscess and TPVB has a
      chance of epidural spread and pneumothorax, and multiple injections are needed if more than 4
      dermatome analgesia is required. Recently, erector spinae plane block (ESPB) was reported as
      a treatment for thoracic neuropathic pain.

      ESPB is a relatively simple technique with easily identified sonographic landmarks, and a
      catheter is easily inserted into the plane after distention induced by the injection.
      Additionally, the ESPB has the potential to provide both somatic and visceral sensory
      blockade.

      The selectivity of dexmedetomidine to the α2-receptors is eight times of its prototype,
      clonidine. Accordingly, dexmedetomidine is a more powerful sedative and analgesic drug than
      clonidine with less hemodynamic derangements from the α1-receptor activation. Dexmedetomidine
      has been primarily used for intra- venous sedation in intensive care settings. The unique
      analgesic properties of dexmedetomidine have encouraged the anesthesiologists to use it
      perineurally. Previous studies have declared that dexmedetomidine potentiates local
      anesthetic effect when administered by neuroaxial route.

      This study aims to evaluate the effect ultrasound erector spinae plane block with
      dexmedetomidine infusion in management of acute and chronic post thoracotomy pain.
    

Intervention name(s): Thoracic epidural analgesia; ESPB with levobupivacaine and dexmedetomedine; ESPB with levobupivacaine
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): Patients will preoperatively receive thoracic epidural at the level T5 & T6 with bolus 20 ml of levobupivacaine 0.25% then levobupivacaine 0.1% infused at a rate of 0.1 mL/Kg/hr until chest tube removal ( 5-6 days).; patients will preoperatively receive US guided ESP block on the side to be operates upon, the puncture point of the skin is infiltrated with 2% lidocaine, and once the structures are identified with ultrasound at the level of T5 transverse process, we will inject bolus 20ml of levobupivacaine 0.25% plus 0.5mic/Kg dexmedetomidine on the deep aspect of erector spinae muscle then catheter inserted. 20 ml bolus of levobupivacaine 0.1% with dexmedetomidine 0.5 μg/Kg was injected every 6 hours until chest tube removal.; patients will preoperatively receive US guided ESP block on the side to be operates upon, the puncture point of the skin is infiltrated with 2% lidocaine, and once the structures are identified with ultrasound at the level of T5 transverse process, we will inject bolus 20ml of levobupivacaine 0.25% on the deep aspect of erector spinae muscle then catheter inserted.A 20 ml bolus of levobupivacaine 0.1% is injected every 6 hours until chest tube removal.
Intervention MeSH terms: Levobupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention